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)

Given the recent interest in the subjective or phenomenal dimension of consciousness it is no wonder that many authors have once more started to speak of the need for pheno- menological considerations. Often however the term ‘phenomenology’ is being used simply as a synonym for ‘folk psychology', and in our article we argue that it would be far more fruitful to turn to the argumentation to be found within the continental tradition inaugurated by Husserl. In order to exemplify this claim, (...) we criticize Rosenthal's higher-order thought theory as well as Strawson's recent contribution in this journal, and argue that a phenomenological analysis of the nature of self-awareness can provide us with a more sophisticated and accurate model for understanding both phenomenal consciousness and the notion of self. (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)

Until recently, cognitive research in infantile autism primarily focussed on the ability of autistic subjects to understand and predict the actions of others. Currently, researchers are also considering the capacity of autists to understand their own minds. In this article we discuss selected recent contributions to the theory of mind debate and the study of infantile autism, and provide an analysis of intersubjectivity and self-awareness that is informed both by empirical research and by work in the phenomenological tradition. This analysis (...) uncovers certain problems in the theory-theory account of autism, and at the same time illustrates the potential value of phenomenology for cognitive science. (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)

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)

Psychiatry has long struggled with the nature of its diagnoses. This book brings together established experts in the wide range of disciplines that have an interest in psychiatric nosology. The contributors include philosophers, psychologists, psychiatrists, historians and representatives of the efforts of DSM-III, DSM-IV and DSM-V.

The notion of minimal, basic, pre-reflective or core self is currently debated in the philosophy of mind, cognitive sciences and developmental psychology. However, it is not clear which experiential features such a self is believed to possess. Studying the schizophrenic experience may help exploring the following aspects of the minimal self: the notion of perspective and first person perspective, the ‘mineness’ of the phenomenal field, the questions of transparency, embodiment of point of view, and the issues of agency and ownership, (...) considered as different and less fundamental than the feeling of mineness. Two clinical vignettes of patients with the diagnosis of schizophrenia will be presented: the first one, illustrating early illness stages, and the second case, of chronic schizophrenia, symptomatically marked by persistent hallucinations. Through their analysis, we will discuss the experiential dimensions of minimal self. (shrink)

Auditory verbal hallucinations form an essential criterial feature in the schizophrenia definition in the Diagnostic and Statistical Manual of Mental Disorders -IV and International Classification of Diseases -10. In both classificatory systems, the presence of a hallucinatory voice that continuously comments the patient’s behavior or thoughts, or the presence of several voices that discuss the patient with each other, is a sufficient criterion to diagnose schizophrenia. The DSM-IV defines a hallucination as “a sensory perception that has the..

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)

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)

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)

The purpose of this article is to show how schizophrenia, understood as a distortion of the most intimate structures of subjectivity, illustrates the nature of subjectivity as such, while at the same time how philosophical considerations may help to understand schizophrenia. More precisely, schizophrenic experiences of self-alienation seem to reflect a congealing or concretization of a form of differentiation or potential alterity implicit in the dynamic nature of subjectivity. In other words, we propose that the structure of subjectivity includes potential (...) divisions and fissures that condition the experiences of radical self-alienation seen in schizophrenia. In order to elucidate how this alterity emerges within the self in schizophrenia and in order to consider its conditions of possibility we examine the disorders of the self as described in phenomenological psychopathology. We especially use the work of the Japanese psychiatrists Mari Nagai, her teacher Bin Kimura, and the French psychiatrist Henry Ey, supplemented with clinical material from our own research. Finally, we shed light on the development of the psychotic symptoms such as hallucinations and delusions, which are understood as the expressions of a radical alterization of the self. (shrink)

Delusions are usually defined as false beliefs about the state of affairs in the public world. Taking this premise as unquestionable, the debate in cognitive science tends to oscillate between the so-called 'rationalist approach'- proposing some breakdown in the central intellective modules embodying human rationality - and the 'empiricist approach' - proposing a primary peripheral deficit , followed by explanatory efforts in the form of delusions. In this article the foundational assumption about delusion is questioned. Especially in the case of (...) schizophrenia, delusions are not epistemic statements about external world but metaphorical reports of altered structure of experiencing . Delusions as epistemic statements or beliefs occur paradigmatically in delusional disorder . These two types of delusions are compared from a primarily phenomenological stance. (shrink)

This volume presents essays on self-consciousness by prominent psychologists, cognitive neurologists, and philosophers.

Psychiatry has been subject to major changes in the last 150 years. This book explores the forces that have shaped these changes and how they have impacted on the psychiatric profession in this time. The result is a dynamic discussion about the nature of psychiatric disorders, and a book that is compelling reading.

The first commentary that we discuss is the quite critical one by Thomas and Long-den. The pertinent question is if the authors’ criticism hits the mark or if it is simply off the mark? We will let the reader decide. In the following, we address some of the most important problems in their commentary. First, Thomas and Longden seem to conflate the concept of pathogenesis with that of etiology. We have presented a phenomenological account of the pathogenesis of some auditory (...) verbal hallucinations in schizophrenia —an account based on empirical data.. (shrink)

Levels of Analysis in Psychopathology draws research from psychiatry, philosophy, and psychology to explore the variety of explanatory approaches for understanding the nature of psychiatric disorders both in practice and research. The fields of psychiatry and clinical psychology incorporates many useful explanatory approaches and this book integrates this range of perspectives and makes suggestions about how to advance etiologic theories, classification, and treatment. The editors have brought together leading thinkers who have been widely published and are well-respected in their area (...) of expertise, including several developers of the Diagnostic and Statistical Manual of Mental Disorders and authors of the US National Institute of Mental Health's Research Domain Criteria Project. Each main chapter has a commentary provided by one of the other authors and an introduction written by one of the editors to create an accessible, interdisciplinary dialog. (shrink)

The revisions of both DSM-IV and ICD-10 have again focused the interest of the field of psychiatry and clinical psychology on the questions of nosology. This book reviews issues within psychiatric nosology from clinical, historical and particularly philosophical perspectives. It brings together an interdisciplinary group of distinguished authors.