In recent years, there has been much focus on the apparent heterogeneity of schizophrenic symptoms. By contrast, this article proposes a unifying account emphasizing basic abnormalities of consciousness that underlie and also antecede a disparate assortment of signs and symptoms. Schizophrenia, we argue, is fundamentally a self-disorder or ipseity disturbance that is characterized by complementary distortions of the act of awareness: hyperreflexivity and diminished self-affection. Hyperreflexivity refers to forms of exaggerated self-consciousness in which aspects of oneself are experienced as akin (...) to external objects. Diminished self-affection or self-presence refers to a weakened sense of existing as a vital and self-coinciding source of awareness and action. This article integrates recent psychiatric research and European phenomenological psychiatry with some current work in cognitive science and phenomenological philosophy. After introducing the phenomenological approach along with a theoretical account of normal consciousness and self-awareness, we turn to a variety of schizophrenic syndromes. We examine positive, then negative, and finally disorganization symptoms—attempting in each case to illuminate shared distortions of consciousness and the sense of self. We conclude by discussing the possible relevance of this approach for identifying early schizophrenic symptoms. (shrink)

Phenomenological psychiatry has suffered from a failure to translate its insights into terms specific enough to be applied to psychiatric diagnosis or to be used in contemporary research programs. This difficulty can be understood in light of the well-known tradeoff between reliability and validity. We argue, however, that with sufficient ingenuity, phenomenological concepts can be adapted and applied in a research context. Elsewhere, we have described a phenomenologically oriented conception of schizophrenia as a self- or ipseity-disorder with two main facets: (...) decline in the sense of existing as a subject of awareness (diminished self-affection) and heightened awareness of aspects of experience that would normally remain tacit or presupposed (hyperreflexivity). This approach is consistent with Minkowski, Blankenburg, and Kimura and offers one possible synthesis of their views. Here we describe two areas of empirical research that are congruent with, or actually inspired by, a phenomenological approach emphasizing such disorders of consciousness and self-experience: (1) Phenomenologically oriented, interview studies show that, whereas negative-symptom patients generally deny any diminishment of affect and thinking, they do describe qualitative alterations of experience suggestive of hyperreflexivity and diminished self-affection. (2) Another line of research suggests that the early detection of schizophrenic symptoms may be enhanced by adopting a phenomenological approach. (shrink)

This article examines the structure of self-consciousness in people with schizophrenia. The findings indicate that our self-experience is not neutral with respect to the metaphysical status of the self and that it is important to attend carefully to the experience of the subject in order to understand schizophrenia. The results also suggest that the variable disruptions in the sense of self-presence, first-person perspective, and the phenomenality of experience in schizophrenics directly affect the minimal self and it may also have implications (...) for the narrative self. (shrink)

We propose that typical schizophrenic delusions develop on the background of preexisting anomalies of self-experience. We argue that disorders of the Self represent the experiential core clinical phenomena of schizophrenia, as was already suggested by the founders of the concept of schizophrenia and elaborated in the phenomenological psychiatric tradition. The article provides detailed descriptions of the pre-psychotic or schizotypal anomalies of self-experience, often illustrated through clinical vignettes. We argue that delusional transformation in the evolution of schizophrenic psychosis reflects a global (...) reorganization of consciousness and existential reorientation, both of which radiate from a fundamental alteration of the Self. We critically address the contemporary cognitive approaches to delusion formation, often finding them inconsistent with the clinical features of schizophrenia or implausible from a phenomenological point of view. (shrink)

In this response to Wiggins and Schwartz, Ratcliffe, and Stanghellini, we first wish to express our gratitude to Philosophy, Psychiatry, and Psychology for providing us the space to clarify our views and to overcome certain misunderstandings. Ratcliffe notes that our critique is "harsh," whereas Wiggins and Schwartz lament the fact that the debate "has taken the form of sometimes acid formulations and rejoinders . . . that lack the tone of mutual appreciation" (2011, 31). We deplore the fact that this (...) exchange was at all necessary, and we share Wiggins and Schwartz's concerns. However, we need to recall here and emphasize that our article originated as a response. It originated as a response to an article that was .. (shrink)

The phenomenological approach to schizophrenia has undergone something of a renaissance in Anglophone psychiatry in recent years. There has been a proliferation of works that focus on the nature of subjectivity in schizophrenia and related disorders, and that take inspiration from the work of such German and French philosophers as Husserl, Heidegger, and Merleau-Ponty, and such classical psychiatrists as Minkowski, Blankenburg, and Binswanger (Rulf 2003; Sass 2001a, 2001b). This trend includes predominantly theoretical articles, which typically incorporate clinical material as (...) well as reviews of empirical and experimental findings in psychopathology. Some very recent examples (since 2000) are studies of .. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 11.1 (2004) 71-80 [Access article in PDF] Some Reflections on the (Analytic) Philosophical Approach to Delusion Louis A. Sass There are more things in heaven and earth, Horatio, Than are dreamt of in your philosophy." —Hamlet, Act I, Scene 5 The peculiar, often problematic phenome na of psychopathology have been attract ing the attention of analytic philosophers in recent years. The topic of (...) delusion has been a particular draw, with a number of analytic philosophers attempting to use their conceptual tools, usually combined with ideas from cognitive neuroscience, to criticize the traditional understanding and to clarify the nature of this central psychiatric topic. It is useful to have this kind of interdisciplinary dialogue. Indeed, there is good reason to hope that concepts honed in the philosophy of mind and other philosophical subfields will help to sort out our understanding of a phenomenon (or set of phenomena) for which contemporary psychiatric definitions and conceptualizations are clearly inadequate and, in some respects, downright misleading (see Parnas and Sass 2001; Spitzer 1990).1Here, however, I would like to call attention to some weaknesses that, it seems to me, are rather common (I do not say universal) in many analytic philosophical approaches to psychopathology. In my opinion, there is a tendency to formulate issues and arguments in overly polarized, even dichotomous terms, and then to rely too uncritically on these essentialistic formulations in exploring the domain of inquiry. Although this polarizing tendency sometimes has the salutary effect of clarifying conceptual domains, it can, when taken too far, actually hamper our understanding of phenomena that are often fraught with ambiguities and complexities that defy many standard conceptualizations.The relationship between philosophy and psychopathology is obviously a two-way street—we are familiar, for example, with disorders that challenge deep philosophical assumptions about self and mind (e.g., blindsight, split-brain phenomena, perhaps also Dissociative Identity Disorder, and the first rank symptoms of schizophrenia). I am suggesting that, in their work on delusions, philosophers may need to put more emphasis on moving from the natural phenomena [End Page 71] of psychopathology and to the domain of philosophical analysis.I believe that a greater sensitivity to the modes of knowing associated with the phenomenological tradition, and to the forms of conceptual self-critique fostered by Ludwig Wittgenstein, are crucial ingredients for any adequate approach to delusion as well as many other topics in psychopathology. In my opinion, the work of many analytic philosophers interested in psychopathology would be enriched if they spent more time trying to discover and imagine what it might be like to experience certain kinds of abnormal psychiatric conditions, and also speculating about what implications such experiential modalities might have for action and verbal expression. I believe they would also be wise to spend more time questioning, and attempting to transcend, the philosophically derived conceptual distinctions and dichotomies that appear to organize their conceptual universes. Phenomenological imagination and Wittgensteinian critique can show how to move outside the conceptual capsule and into the rich and strange realms of actual experience, both normal and abnormal.So far I have offered only slogans. Let me use the articles by Tim Bayne and Elisabeth Pacherie (2004) and Robert Klee (2004) to flesh out the criticisms I have offered. There is much that is intelligent and much that is worthwhile in both their articles. (For example, I was largely convinced by the criticisms of John Campbell and of Donald Davidson that are central to the articles by Bayne and Pacherie and by Klee, respectively.) Here, however, I will focus only on issues that illustrate the above-mentioned tendencies—tendencies that, in my view, tend to infect even the best writings on the (analytic) philosophy of psychiatry. I will also make some remarks about the works of Campbell and Davidson, the two philosophers criticized in the articles by Bayne and Pacherie and by Klee. Because the article by Eugenie Georgaca (2004) is in a different tradition, I will say only a few words about it at the end. Bayne and Pacherie on the Preservation-Of-meaning... (shrink)

This multidisciplinary collection explores three key concepts underpinning psychiatry -- explanation, phenomenology, and nosology -- and their continuing relevance in an age of neuroimaging and genetic analysis. An introduction by Kenneth S. Kendler lays out the philosophical grounding of psychiatric practice. The first section addresses the concept of explanation, from the difficulties in describing complex behavior to the categorization of psychological and biological causality. In the second section, contributors discuss experience, including the complex and vexing issue of how self-agency and (...) free will affect mental health. The third and final section examines the organizational difficulties in psychiatric nosology and the instability of the existing diagnostic system. Each chapter has both an introduction by the editors and a concluding comment by another of the book's contributors. Contributors: John Campbell, Ph.D.; Thomas Fuchs, M.D., Ph.D.; Shaun Gallagher, Ph.D.; Kenneth S. Kendler, M.D.; Sandra D. Mitchell, Ph.D.; Dominic P. Murphy, Ph.D.; Josef Parnas, M.D., Dr.Med.Sci.; Louis A. Sass, Ph.D.; Kenneth F. Schaffner, M.D., Ph.D.; James F. Woodward, Ph.D.; Peter Zachar, Ph.D. (shrink)

According to Louis Sass, Josef Parnas, and Dan Zahavi (2011), the account of current developments in "phenomenological clinical neuroscience" offered by Aaron Mishara (2007) is "not only confusing but highly inaccurate." Their critique is harsh, but I can find nothing to disagree with. Mishara's distinction between "neo-phenomenology" and "existential phenomenology" does not apply to current work in the field; I do not recognize the two camps he describes. Neither do I find it helpful to distinguish two separate (...) historical traditions in phenomenological psychiatry. As for allegedly conflicting phenomenological claims, Sass, Parnas, and Zahavi rightly point out that an emphasis on involuntary hyperreflexivity is .. (shrink)

This article by Louis Sass, Josef Parnas, and Dan Zahavi takes us into the midst of a debate over recent developments in phenomenological psychiatry. In "Phenomenological Psychopathology and Schizophrenia: Contemporary Approaches and Misunderstandings" (Sass et al. 2011), Sass et al. are responding to criticisms of their position lodged by Aaron L. Mishara in "Missing Links in Phenomenological Clinical Neuroscience: Why We Are Still Not There Yet" (Mishara 2007). In their reply, Sass et al. offer (...) several helpful clarifications and justifications of their position, a position they have advanced in numerous important articles and books in the past. We are grateful for these clarifications and additional .. (shrink)

Dan Zahavi, the editor of this collection, heads the Center for Subjectivity Research, at the University of Copenhagen. The essays reflect the interests of the Center and seek to address the following issue: To what extent can the current discussion of consciousness in mainstream cognitive science and analytical philosophy of mind profit from insights drawn from the investigations of subjectivity found in the Kantian and post-Kantian tradition as well as in the phenomenological and hermeneutical tradition. The contributions include some that (...) are philosophical, while others relate to issues in empirical science, such as psychopathology, cognitive neuroscience, and developmental psychology.Contributors include Andrew Brook, John Drummond, Shaun Gallagher, Arne Groen, Josef Parnas, Peter Poellner, Sonja Rinofner-Kreidl, Louis Sass, Dieter Teichert and Dan Zahavi. (shrink)

In this paper I aim to re-think the question of the world of persons with schizophrenia from the perspective of the German phenomenologist Max Scheler and that of the Japanese psychiatrist Bin Kimura. So far, no comparison between these two authors has been made, even though there are several convergences and evidence of Scheler’s indirect influence on Bin Kimura through Viktor von Weizsäcker. In recent years, Dan Zahavi, Louis Sass, and Josef Parnas have interpreted the modus vivendi (...) of schizophrenic patients in relation to a disturbance on the level of the “minimal self”. Subsequently, the discussion has highlighted the importance of disorders on the level of intercorporeality and intersubjectivity (Thomas Fuchs) and on the level of “existential feelings” (Matthew Ratcliffe). This paper argues that Max Scheler and Bin Kimura allow us to focus on an aspect which has been neglected so far: that of a “relational self” that relates to the very foundation of intersubjectivity and intercorporeality and that can thus be reborn in the encounter with the other and may position itself differently in the world. In Scheler’s perspective, the world of persons with schizophrenia is the result of an axiological disorder (valueception) that impairs contact with the primordial life impulse (Lebensdrang). As a consequence, they are incapable of attuning emotionally and socially with others: this prevents the singularity from being reborn in the encounter with the other and forces them to position themselves in their own solipsistic universe. Moving in a similar direction, Bin Kimura interprets the world of persons with schizophrenia as the result of a disorder of aida (one of the central concepts of Japanese culture that indicates the space of being in between). The disorder of aida compromises the basic relationship (Grundverhältnis in the sense of Viktor von Weizsäcker) and hinders what Bin Kimura calls festum, i.e. the birth of subjectivity, so that it is experienced by persons with schizophrenia only as ante festum. Starting from these two perspectives, I argue the existence of an axiological and anthropogenetic dimension of psychopathology. I begin with a discussion of Zahavi’s concept of minimal self and the thesis that reveals the disorders on this level of subjectivity as the origin of the world of persons with schizophrenia. I, then, analyze Max Scheler’s position and its historic importance for the emergence of phenomenological psychopathology. Thereafter, I introduce the concepts of “disorder of aida” (Bin Kimura) and “disorder of ordo amoris” (Max Scheler). Finally, I develop the concept of a “psychopathology of ordo amoris” by also comparing it with Ratcliffe’s thesis of “existential feelings”. (shrink)

The variety of symptoms associated with schizophrenia are not easily unified under one coherent concept. Nevertheless, under the gaze of phenomenology, a disturbance of pre-reflexive experience has become increasingly apparent as the basis of the condition, which has so far been understood in two different ways: on the one hand, as a disturbance of basal self-experience, of my-ness or ipseity (Louis Sass, Josef Parnas, Dan Zahavi) and on the other hand, as a disturbance of the passive synthesis (...) of inner time consciousness (Aaron Mishara, Shaun Gallagher, Thomas Fuchs). The present work introduces a link between the two approaches by regarding the basal self-experience grounded in an inner time consciousness. Schizophrenia is thus described as a disturbance of the temporal constitution of self-experience, which on the one hand causes self-alienation and on the other impairs the pre-reflexive, embodied performance of thinking, perceiving and moving. These analyses are then applied to the social dimension of the disorder, which manifests itself, among other symptoms, in the loss of spontaneous attunement with others. (shrink)

The present paper reflects on hallucination and delusion in schizophrenia from a phenomenological perspective. The paper’s aim is to understand the relationship between these two symptoms within the theoretical paradigm of schizophrenia as a self-disorder. The paper draws on fundamental insights from contemporary phenomenological research by Louis A. Sass, Josef Parnas and Thomas Fuchs. The argument begins with current definitions of hallucination and schizophrenia in the DSM-5. I will critically illuminate these definitions by key thinkers of phenomenological (...) psychopathology (or close to it), such as Karl Jaspers, Eugène Minkowski, Henri Ey and Merleau-Ponty. The paper’s main challenge is to understand hallucination and delusion beyond their respective alignment with perception (as though hallucination would simply be a perception without an object to perceptive) or false belief (as if delusion would simply be an absurd conviction). (shrink)