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)

Many with schizophrenia find social interactions a profound and terrifying threat to their sense of self. To better understand this we draw upon dialogical models of the self that suggest that those with schizophrenia have difficulty sustaining dialogues among diverse aspects of self. Because interpersonal exchanges solicit and evoke movement among diverse aspects of self, many with schizophrenia may consequently find those exchanges overwhelming, resulting in despair, the sensation of fusion with another, and/or self-dissolution. In short, compromised (...) dialogical capacities may be a contributing factor to social dysfunction in schizophrenia. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 8.4 (2001) 339-341 [Access article in PDF] Schizophrenia and Self-Awareness Dan Zahavi In his paper, "Cogito and I: A Bio-Logical Approach," Kimura Bin raises a number of intriguing issues. Let me in the following address a few of them. Kimura Bin's point of departure is the idea that schizophrenia is basically to be understood as a disorder of self and self-experience. Thus, fundamental (...) alterations in the sense of possession and control of one's own thoughts, actions, sensations, or emotions figure among the most prominent symptoms in its advanced stages. But even in the absence of overt symptoms, the schizophrenic may feel uncertain about her selfhood, and it is often in an attempt to restore or at least sustain her precarious self-identity that the patient engages in characteristic obsessive self-reflections that frequently simply exacerbate the problem.1. One way to illustrate what is peculiar about the self-disorder in schizophrenia is by contrasting it with the symptoms found in senile dementia. Whereas the demented patient might lack any knowledge about the features that characterize him from a third-person perspective, i.e., age, nationality, profession, location, etc., he is usually in possession of an intact first-person perspective: He is still aware of the I-Here-Now. In schizophrenia, the problem is typically exactly the reverse (Tatossian 1997, 26). This contrast makes it tempting to argue, as Kimura Bin in fact does, that we need to distinguish two different dimensions of selfhood: the self as subject and the self as object. Of course, by making that distinction, we are immediately partaking in a classical philosophical discussion. Thus, at least since Kant, it has been customary to distinguish between the transcendental subject and the empirical or mundane subject. This distinction can be cashed out as a distinction between two different ways of being aware of oneself, one external, the other internal. On the one hand, I can think of myself from a third-person perspective, that is, I can refer to an object by way of a proper name, a demonstrative, or a definite description, and occasionally this object happens to be myself. When I refer to myself in this way, I am referring to myself in exactly the same way that I can refer to Others, and Others can refer to me (the only difference being that I am the one doing it, thus making the reference into a kind of self-reference). Apart from being external and contingent, this kind of self-reference is also non-thematic, since it can occur without my knowledge of it, that is, I can refer to myself from the third-person perspective without realizing that I myself am the referent. In contrast, the self-reference available from the first-person perspective—the one expressed in the subject-use of "I"—is of an internal kind. Not only is it impossible to refer to anybody and anything apart from oneself in the first-person way, but it also belongs to the proper use of "I" that one knows that one is referring to oneself. That is, apart from being internal and necessary, the self-reference in question is also of a thematic nature. In [End Page 339] more traditional terms: One can be conscious of oneself as an empirical object with mental properties, and one can be conscious of oneself as the subject of intentionality. Or again, one can be aware of oneself as a causally determined known object, as a part of the world, and one can be aware of oneself as a knowing subject, as—to paraphrase Wittgenstein—the limit of the world. In short, the difference between the empirical subject and the transcendental subject is closely linked to the difference between being aware of oneself as an object in the world and being aware of oneself as a subject for the world.Utilizing this distinction, it can be said that schizophrenia involves a disturbance on the transcendental level (this way of speaking would, by the way, be anathema to a classical Kantian transcendental philosophy but more acceptable to the... (shrink)

In this paper, I give a Kantian answer to the question whether and why it would be inappropriate to blame people suffering from mental disorders that fall within the schizophrenia spectrum. I answer this question by reconstructing Kant’s account of mental disorder, in particular his explanation of psychotic symptoms. Kant explains these symptoms in terms of various types of cognitive impairment. I show that this explanation is plausible and discuss Kant’s claim that the unifying feature of the symptoms is (...) the patient’s inability to enter into an exchange of reasons with others. After developing a Kantian Quality of Will Thesis, I analyze some real life cases. Firstly, I argue that delusional patients who are unable to enter into an exchange of epistemic reasons are exempted from doxastic rather than moral responsibility. They are part of the moral community and exonerated from moral blame only if their actions do not express a lack of good will. Secondly, I argue that disorganized patients who are unable to form intentions and to make plans are exempted from moral responsibility because they do not satisfy the conditions for agency. (shrink)

Uttered language does not necessarily reflect the planned communications of schizophrenia patients, nor do their delusions necessarily reflect basic failures of inferential reasoning. The role of inhibitory failure in the production of speech and the role of primary experiences of discrepancy between intention and action, and between experience–based expectations and perceived realities account for many of the clinical phenomena that have led to the conclusion that these patients have a ‘thought’ disorder, or a ‘disturbed’ mind. The alternatives and the (...) evidence are summarized in this paper. (shrink)

A new etiological model is proposed for schizophrenia that combines variability‐enhancing nonspecific factors acting during development with more specific risk factors. This model is better suited than the current etiological models of schizophrenia, based on the risk factors paradigm, for predicting and/or explaining several important findings about schizophrenia: high co‐morbidity rates, low specificity of many risk factors, and persistence in the population of the associated genetic polymorphisms. Compared with similar models, e.g., de‐canalization, common psychopathology factor, sexual‐selection, or (...) differential sensitivity to the environment, this proposal is more general and integrative. Recently developed research methods have proven the existence of genetic and environmental factors that enhance developmental variability. Applying such methods to newly collected or already available data can allow for testing the hypotheses upon which this model is built. If validated, this model may change the understanding of the etiology of schizophrenia, the research models, and preventionbrk paradigms. (shrink)

A family of recent externalist approaches in philosophy of mind argues that our psychological capacities are synchronically and diachronically “scaffolded” by external resources. I consider how these “scaffolded” approaches might inform debates in phenomenological psychopathology. I first introduce the idea of “affective scaffolding” and make some taxonomic distinctions. Next, I use schizophrenia as a case study to argue—along with others in phenomenological psychopathology—that schizophrenia is fundamentally a self-disturbance. However, I offer a subtle reconfiguration of these approaches. I argue (...) that schizophrenia is not simply a disruption of ipseity or minimal self-consciousness but rather a disruption of the scaffolded self, established and regulated via its ongoing engagement with the world and others. I conclude by considering how this scaffolded framework indicates the need to consider new forms of intervention and treatment. (shrink)

First published in 1976, Schizophrenia: The Sacred Symbol of Psychiatry examines the concept of schizophrenia and the origins of its classification as a disease. Szasz convincing argues that rather than a medical diagnosis, the word schizophrenia is a symbol employed by psychiatrists as a means of control.

Phillips & Singer's compelling presentation is weakest in its demonstration of commonalities between sensory plasticity and higher forms of learning and behavior. We propose that available data on schizophrenia can provide such evidence, because of the presence of impairments in a number of functions central to their model, and strong relationships between these dysfunctions and behavior.

Traditionally, phenomenological theories of schizophrenia have emphasized disturbances in self-experience, with relatively little acknowledgement of the surrounding world. However, epidemiological research consistently demonstrates a strong relationship between traumatic and stressful life events and the development of schizophrenia, suggesting that encounters in the world are highly relevant for many people diagnosed with this disorder. This paper reviews foundational texts in phenomenology and phenomenological psychopathology on the nature of subjectivity and its disturbances, finding support for broadening contemporary phenomenological models of (...) schizophrenia to incorporate world events and their subjective meaning as essential aspects of this disorder. This contextual approach to phenomenology emphasizes the relationship between self and world, one that is especially unstable, unclear, and untrustworthy in schizophrenia. Both epidemiological and phenomenological research can benefit from this approach: in epidemiology, researchers might consider the ways that various risk factors are experienced by persons vulnerable to schizophrenia, while phenomenologists are encouraged to inquire about the environmental and social context in which altered experiences occur and incorporate these considerations into their explanatory models. (shrink)

Schizophrenia is a mental disorder that calls the mineness of one's own sensations, thoughts and actions into question and threatens the person with a loss of self. In order to understand this illness in its essence, an approach based on phenomenological psychopathology is therefore indispensable. Conversely, disorders of the self in schizophrenia should be of crucial interest for any philosophy of subjectivity in order to test its concepts of self-awareness, personhood and intersubjectivity by reference to empirical phenomena.Contemporary neurobiological (...) concepts of schizophrenia predominantly emphasize the importance of impaired integration of somatosensory inputs into stable central-nervous representations... (shrink)

The repeatedly noted absence of case-reports of individuals with schizophrenia and congenital/early developed blindness has led several authors to argue that the latter can confer protective effects against the former. In this work, we present a number of relevant case-reports from different syndromes that show comorbidity of congenital and early blindness with schizophrenia. On the basis of these reports, we argue that a distinction between different types of blindness in terms of the origin of the visual deficit, cortical (...) or peripheral, is crucial for understanding the observed patterns of comorbidity. We discuss the genetic underpinnings and the brain structures involved in schizophrenia and blindness, with insights from language processing, laying emphasis on the three structures that particularly stand out: the occipital cortex, the lateral geniculate nucleus and the pulvinar. Last, we build on previous literature on the nature of the protective effects in order to offer novel insights into the nature of the protection mechanism from the perspective of the brain structures involved in each type of blindness. (shrink)

Recent debates concerning the abolition of the schizophrenia label in psychiatry have focused upon problems with the scientific status of the concept. In this article, I argue that rather than attacking schizophrenia for its lack of scientific validity, we should focus on the conceptual history of this label. I reconstruct a specific tradition when exploring the conceptual history of schizophrenia. This is the concern with the question of the sense of life itself, conducted through the confrontation with (...) schizophrenia as a form of life that does not live, or as Robert Jay Lifton termed it ‘lifeless life’ (1979: 222—39). I conclude by arguing that the contemporary attempt to deconstruct or abolish the schizophrenia concept involves a fundamental shift in concern. The attempt both to normalize psychotic experiences, and to conceive them purely in terms of cognitive processes that can be mapped onto brain function, results in a fundamental move away from the attempt to understand the experience of madness. (shrink)

Do self‐monitoring accounts, a dominant account of the positive symptoms of schizophrenia, explain auditory verbal hallucination? In this essay, I argue that the account fails to answer crucial questions any explanation of auditory verbal hallucination must address. Where the account provides a plausible answer, I make the case for an alternative explanation: auditory verbal hallucination is not the result of a failed control mechanism, namely failed self‐monitoring, but, rather, of the persistent automaticity of auditory experience of a voice. My (...) argument emphasizes the importance of careful examination of phenomenology as providing substantive constraints on causal models of the positive symptoms in schizophrenia. (shrink)

I begin by examining how genetics drivesschizophrenia research, and raise both familiar andrelatively novel criticisms of the evidence putativelysupporting the genetic basis of schizophrenia. Inparticular, I call attention to a set of concernsabout the effects of placentation on concordance ratesof schizophrenia in monozygotic twins, which furtherweakens the case for schizophrenia''s so-called stronggenetic component. I then underscore two criticalpoints. First, I emphasize the importance of takingseriously considerations about the complexity of bothontogenesis and the development of hereditarydiseases. The recognition (...) of developmentalconstraints and supports is crucial, for attention todevelopment exposes the naivete of too many models ofgene action in the aetiology of disease. Secondly, Iattend to those schizophreniologists who ignoremethodological criticisms and thus presume a geneticbasis for schizophrenia, and then seek the schizophrenic genotype lacking an adequatephenotype. In response I attempt to demonstrate thenecessity of a sustained effort at characterizing thephenotype of schizophrenia as an enabling conditionfor the whole enterprise of psychiatric genetics – andfor psychiatry itself. Without the organism-levelphenotype, research at the level of genes will remainunproductive – assuming of course that research at thegenetic level is appropriate at all. (shrink)

A diagnosis of schizophrenia is often taken to denote a state of global irrationality within the psychiatric paradigm, wherein psychotic phenomena are seen to equate with a lack of mental capacity. However, the little research that has been undertaken on mental capacity in psychiatric patients shows that people with schizophrenia are more likely to experience isolated, rather than constitutive, irrationality and are therefore not necessarily globally incapacitated. Rational suicide has not been accepted as a valid choice for people (...) with schizophrenia due in part to a belief that characteristic irrationality prevents autonomous decision-making. Since people with schizophrenia are often seen to lack insight into the nature of their disorder, both psychiatric and ethical perspectives generally presume that suicidal acts result directly from mental illness itself and not from second-order desires. In this article, I challenge notions of global irrationality conferred by a diagnosis of schizophrenia and argue that, where delusional beliefs are unifocal, schizophrenia does not necessarily lead to a state of mental incapacity. I then attempt to show that people with schizophrenia can sometimes be rational with regard to suicide, where this decision stems from a realistic appraisal of psychological suffering. (shrink)

In various ways, schizophrenia seems to involve an anomalous form of collective intentionality. Many patients report notable difficulties in establishing and maintaining relationships to others, which often may lead to social withdrawal, isolation, and pro-found feelings of solitude. What is puzzling is of course not that patients, despite their interpersonal difficulties, participate in or try to participate in various social activities, but that some of these social activities appear quite tolerable to the patients, whereas other activities seem almost unbearable. (...) The aim of this paper is to shed light on this aberrant social behaviour by clarifying the relations between schizophrenia and collective intentionality. (shrink)

Schizophrenia involves significant disturbances to inter-subjective experience, the complex nature of which have become an increasingly important area for research in the philosophy of psychiatry. In “Schizophrenia as a Problem of Other Minds,”, Brighupati Singh offers a thought-provoking contribution to this trajectory by engaging Stanley Cavell’s idea of skepticism: the recognition that ordinary life is inherently fragile, and that the affective attunement between self and other is something that can be undone. Through detailed ethnographic and literary studies, primarily (...) undertaken in the Department of Psychiatry at the All India Institute of Medical Sciences in Delhi, Singh demonstrates how patients with... (shrink)

Temporal experience and its radical alteration in schizophrenia have been one of the central objects of investigation in phenomenological psychopathology. Various phenomenologically oriented researchers have argued that the change in the mode of temporal experience present in schizophrenia can foreground its psychotic symptoms of delusion. This paper aims to further the development of such a phenomenological investigation by highlighting a much-neglected aspect of schizophrenic temporal experience, i.e., its non-emotional affective characteristic. In this paper, it denotes the type of (...) an experience wherein an afflicted individual experiences a pervasive pull or attraction coming from the past, present, and future. By employing Husserl’s account of affection, I argue that such an affectively prominent temporal experience is not yet another abnormality that happens to be present in schizophrenia. Instead, it is indicative of the core disturbance that underpins the schizophrenic temporal mode of experience. I identify such a disturbance as ‘affective modification dysfunction’ and employ it as a core concept with which I synthesize and organise heterogeneous components of schizophrenic temporal experience in their conceptual unity. For the sake of clear description, I organise those components into the following categories: 1.) Time Stop 2.) Ante-festum 3.) Déjà vu/vécu and 4.) Time Fragmentation. I conclude by demonstrating how approaching schizophrenic temporal experience from its affective dimension can further help us better understand its pre-psychotic phase known to precipitate schizophrenic primary delusion, i.e., delusional mood. (shrink)

This paper uses certain of Michel Foucault's ideas concerning modern consciousness (from The Order of Things) to illuminate a central paradox of the schizophrenic condition: a strange oscillation, or even coexistence, between two opposite experiences of the self: between the loss or fragmentation of self and its apotheosis in moments of solipsistic grandeur. Many schizophrenic patients lose their sense of integrated and active intentionality; even their most intimate thoughts and inclinations may be experienced as emanating from, or under the control (...) of, some external being or mysterious foreign soul (‘I feel it is not me who is thinking’; ‘I have been programmed’). Yet the same patients may also experience the self as preeminent, all-powerful or all-knowing (‘My thoughts can influence things’; ‘This event happens because I think it'). Here one may feel confronted with the very paradigm of irrationality: profound contradictions suggesting regression to primitive ‘primary-process’ thinking or utter collapse of the higher faculties of mind. I argue, however, that these dualities so basic to schizophrenia can best be understood very differently: as consequences of a kind of alienation and hyper-self-consciousness (‘hyper- reflexivity') that is closely analogous to what occurs in the post-Kantian era of Western intellectual history. The parallel dualities of modern thought have been most extensively discussed by Foucault, who describes paradoxes, tensions and other dilemmas central to what he calls the modern ‘episteme'; these result from what Foucault sees as the modern human being's introverted and ultimately self-deceiving preoccupation with, and overvaluing of, the phenomenon of his own consciousness. Parallels between these contradictions and those characteristic of several withdrawn schizophrenic individuals are described and analysed. The paper concludes with an Afterword in which some possible neurobiological underpinnings of these schizophrenic experiences are discussed. (shrink)

While schizophrenia may be genetically determined up to a point, neither it nor its nearest relatives offer any sort of reproductive advantage to its sufferers. Instead, from an evolutionary point of view, schizophrenia is benign – it neither promotes nor inhibits survival to reproduction. Because it is benign, its rate of occurrence should remain fairly constant over time.

It is argued that a link prevails between the phenomenology of externality present in classical liberal theory and the state of mind known as schizophrenia. To escape the social reality of possessive individualism, especially the conception of consequences, ends, habits, routine, the schizophrenic individual 'withdraws' or regresses into a psychic universe that contains a dimension unrelated to the consciousness and values of externality: the pursuit of wealth and things, the calculated regard of the other as an instrument for enriching (...) the self. The schizophrenic is incapable of adapting his 'ego' to the necessities of the social environment; he cannot defend himself in 'conventional' or 'normal' ways from the demands of living in a social milieu where the expectations and judgments of others impose intolerable pressures on consciousness. Instead the individual undergoing the painful process of withdrawal constructs a set of psychic defenses that from the standpoint of the external world appear to be 'strange', 'odd', 'bizarre', or 'demented'. The 'mode of Being' of the schizophrenic has nothing in common with the life-style of the acquisitive, status-conscious society. Some consideration is given to the political implications and meaning of the schizophrenic's withdrawal. (shrink)

Schizophrenia in adolescents and the family system Empirical research shows that chronic diseases have specific, idiosyncratic functions in the family, and give real, psychosocial advantages. This leaves the question - can schizophrenic disorders have similar function in the family system as a chronic somatic disease? We have analyzed systemic family traits in families with schizophrenic young patients. The reference samples were two kinds of families: families with schizophrenic adults and families without any chronic disease or chronic illness. The subjects (...) of analysis were coefficients of the systemic features, identified by factor analysis according to author's proposal. Oneway Anova was used to compare indexes between three groups of families. The results show that mental disorder in adolescents participates in the life of the whole family, having similar functions to the functions of chronic somatic diseases. They also suggest that, from the family members' point of view, schizophrenic disorders in a teenagers has different quality compared to schizophrenic disorders in an adult. (shrink)

All mammals have social brains, and there is presently no evidence that humans have relatively more genetically dictated social brain circuitry than other species. The postulation that schizophrenia arises from disruption of brains systems uniquely devoted to social traits is obviated not only by the large number of anatomical and biochemical brain differences, but also by nonsocial symptoms of schizophrenic disorders.

Understanding alterations of selfhood (termed self-disorders or self-disturbances) that are considered typical of the schizophrenia-spectrum is a central focus of phenomenological research. The currently most influential way of phenomenologically conceiving self-disorders in schizophrenia is as disorders of the so-called most basic or “minimal self”. In this paper, we first highlight some challenges for the minimal self-view of self-disorders, focusing on (1) problems arising from the supposedly “essential” or “universal” nature of minimal self with respect to phenomenal awareness and (...) (2) the critical implications of alterations of self-experience in schizophrenia that involve heightened or exaggerated sense of self. In the second part, we tentatively explore how a (non-egological) transparency-view of consciousness may offer an alternative way of understanding the experiential abnormalities involved in self-disorders in schizophrenia. We discuss how such a transparency-view (1) may account for loss-of-self experiences; (2) is compatible with the key notion of “hyper-reflexivity”; and (3) can help explain instances of self-disorder involving increased sense of self. In conclusion, we consider some possible advantages of this alternative view for research on self-disorders and clinical approaches. (shrink)

Decades ago, several authors have proposed that disorders in automatic processing lead to intrusive symptoms or abnormal contents in the consciousness of people with schizophrenia. However, since then, studies have mainly highlighted difficulties in patients’ conscious experiencing and processing but rarely explored how unconscious and conscious mechanisms may interact in producing this experience. We report three lines of research, focusing on the processing of spatial frequencies, unpleasant information, and time-event structure that suggest that impairments occur at both the unconscious (...) and conscious level.We argue that focusing on unconscious, physiological and automatic processing of information in patients, while contrasting that processing with conscious processing, is a first required step before understanding how distortions or other impairments emerge at the conscious level. We then indicate that the phenomenological tradition of psychiatry supports a similar claim and provides a theoretical framework helping to understand the relationship between the impairments and clinical symptoms. We base our argument on the presence of disorders in the minimal self in patients with schizophrenia. The minimal self is tacit and non-verbal and refers to the sense of bodily presence. We argue this sense is shaped by unconscious processes, whose alteration may thus affect the feeling of being a unique individual. This justifies a focus on unconscious mechanisms and a distinction from those associated with consciousness. (shrink)

Schizophrenia is usually described as a fragmentation of subjective experience and the impossibility to engage in meaningful cultural and intersubjective practices. Although the term schizophrenia is less than 100 years old, madness is generally believed to have accompanied mankind through its historical and cultural ontogeny. What does it mean to be “mad”? The failure to adopt social practices or to internalize cultural values of common sense? Despite the vast amount of literature and research, it seems that the study (...) of schizophrenia and of the psychoses is suffering from a generic disintegration. In this introduction, we offer an historical overview of the variety of theories and approaches to schizophrenia. We also provide an overview of how the authors in this volume attempt an integrative account where training, practice, theory and research are considered as parts of a larger whole. This is a varied and pluralistic volume, and it is up to the readers to make use of different chapters according to their own needs. (shrink)

This paper reviews various perspectives regarding the relationship between language and experience, including the challenges of using verbal descriptions to access subjective experience in psychiatric interviews (in both clinical and research settings). Schizophrenia is a specific case in which the experience of language may be altered, posing unique challenges in the context of the interview. The phenomenology of language in schizophrenia is briefly presented, with discussion of related alterations in interpersonal orientation, attention and context, underlying experience, and attitudes (...) toward language. It is suggested that some of the challenges posed by language, particularly in schizophrenia, may be addressed through the use of semi-structured, phenomenologically-informed interviews like the EASE: Examination of Anomalous Self-Experience and the EAWE: Examination of Anomalous World Experience. Guidelines for the administration of these interviews are presented to assist with eliciting descriptions of subjective experience with a higher degree of detail and accuracy. (shrink)

Louis Sass disputes that schizophrenia can be understood successfully according to the hitherto dominant models--for much of what schizophrenics say and do is neither regressive (as psychoanalysis claims) nor just faulty reasoning (as "cognitivists" claim). Sass argues instead that schizophrenics frequently exhibit hyper-rationality, much as philosophers do. He holds that schizophrenic language can after all be interpreted--if we hear it as Wittgenstein hears solipsistic language. I counter first that broadly Winchian considerations undermine both the hermeneutic conception of interpreting other (...) humans in general and Sass's hope of interpreting schizophrenics in particular. I then go on to argue that even if these Winchian considerations are not accepted, Sass in any case doesn't take sufficiently seriously Wittgenstein's use of nonsense as a term of criticism. Solipsism is not something we can understand so as to be able to understand analogically the schizophrenic's "world"--for there is no such thing as understanding it. Solipsism is nonsense, is nothing--there is no "world" there, in solipsists (as I show by reference to Cora Diamond's reading of Wittgenstein). Nor in any actually analogous cases of schizophrenia. Their "alienness" is the alienness of nothingness; roughly, of the fantasy of "logically alien thought". (shrink)

Schizophrenia involves profound but enigmatic disturbances of affective or emotional life. The affective responses as well as expression of many patients in the schizophrenia spectrum can seem odd, incongruent, inadequate, or otherwise off-the-mark. Such patients are, in fact, often described in rather contradictory terms: as being prone both to exaggerated and to diminished levels of emotional or affective response. According to Ernst Kretschmer, they actually tend to have both kinds of experience at the same time. This paper attempts (...) to explain what might be termed this 'Kretschmerian paradox'. Some relevant concepts and vocabulary for affect and emotion are discussed . The need for a phenomenological approach focusing on subjective experience is suggested. Three modes of abnormal experience in schizophrenia are investigated in light of their implications for affect or emotion: alienation of the lived body ; fragmented perception and loss of affordances ; and preoccupation with a quasi-delusional world created by the self. (shrink)

The work of Professor Kraus is more than welcome at a time in which Psychopathology has become increasingly shallow and lacking in density, content with the role of an ideal “observer” whose only ambition is an objective description of signs and symptoms in order to fulfil operational criteria which reliably bestow a place for the case under observation within the grid of diagnostic classification.

Schizophrenia is usually described as a fragmentation of subjective experience and the impossibility to engage in meaningful cultural and intersubjective practices. Although the term schizophrenia is less than 100 years old, madness is generally believed to have accompanied mankind through its historical and cultural ontogeny. What does it mean to be “mad”? The failure to adopt social practices or to internalize cultural values of common sense? Despite the vast amount of literature and research, it seems that the study (...) of schizophrenia and of the psychoses is suffering from a generic disintegration. In this introduction, we offer an historical overview of the variety of theories and approaches to schizophrenia. We also provide an overview of how the authors in this volume attempt an integrative account where training, practice, theory and research are considered as parts of a larger whole. This is a varied and pluralistic volume, and it is up to the readers to make use of different chapters according to their own needs. (shrink)

Ordinarily, if you say something like “I see a comet,” you might make a mistake about whether it is a comet that you see, but you could not be right about whether it is a comet but wrong about who is seeing it. There cannot be an “error of identification” in this case. In making a judgement like, “I see a comet,” there are not two steps, finding out who is seeing the thing and finding out what it is that (...) is being seen, so that you could go wrong at either step. The only place to go wrong is in your description of what is being seen. We usually take it that the same point applies to present-tense ascriptions to oneself of psychological states in general. You can get it wrong about which psychological state you are in, but you cannot get it right about the psychological state but wrong about whose psychological state it is. In contrast, in a room full of people, I might hear a noise and conclude, “Bill sneezed,” and in this case I could be wrong either about who it was that sneezed or about whether it was a sneeze, rather than say a death-rattle. (shrink)

Treatment-resistant symptoms complicate the clinical course of schizophrenia, and a large proportion of patients do not reach functional recovery. In consequence, polypharmacy is frequently used in treatment-refractory cases, addressing psychotic positive, negative and cognitive symptoms, treatment-emergent side effects caused by antipsychotics and comorbid depressive or obsessive-compulsive symptoms. To a large extent, such strategies are not covered by pharmacological guidelines which strongly suggest antipsychotic monotherapy. Add-on strategies comprise combinations of several antipsychotic agents and augmentations with mood stabilizers; moreover, antidepressants and (...) experimental substances are applied. Based on the accumulated evidence of clinical trials and meta-analyses, combinations of clozapine with certain second-generation antipsychotic agents and the augmentation of antipsychotics with antidepressants seem recommendable, while the augmentation with mood stabilizers cannot be considered superior to placebo. Forthcoming investigations will have to focus on innovative pharmacological agents, the clinical spectrum of cognitive deficits and the implementation of cognitive behavioral therapy. (shrink)

Published in 1972, Anti‐Oedipus was the first of a number of collaborative works between the French philosopher, Gilles Deleuze, and the French psychoanalyst and political activist, Felix Guattari. As the first of a two‐volume body of work that bears the subtitle, Capitalism and Schizophrenia, Anti‐Oedipus is, to say the least, an unconventional work that should be understood, in part, as a product of its time – created as it was among the political and revolutionary fervour engendered by the events (...) of ‘May 1968’. However, this paper will suggest that Anti‐Oedipus – as a critique of psychoanalysis and the Oedipus complex, as well as being a study of the relationship between capitalism and schizophrenia – should also be understood in a less ‘time‐bound’ fashion. In particular, the paper will examine Deleuze and Guattari’s formulation of a concept of ‘desire’ and its employment in relation to subjectivity, time, capitalism, representation, and the radical ‘therapeutic’ practice that they refer to as ‘schizoanalysis’. Moreover, nearly 40 years after the events of May 1968 and against possible doubts concerning the contemporary relevance of psychoanalysis, it will be suggested that psychoanalysis and the Oedipus complex are to be understood as symptomatic of a wider ‘malaise’ that can be discerned within psychiatry, psychotherapy, and contemporary capitalist society itself, and that it is this that forms the broader target of the book’s critique. Accordingly, by providing an accessible and critical introduction to Anti‐Oedipus, the paper also hopes to stimulate further discussion and research regarding both the critique and the contribution that the work can make to contemporary psychiatry, psychotherapy, and mental health nursing generally. (shrink)

In his landmark paper, , Michael Stocker introduces an affliction that is, according to his diagnosis, endemic to all modern ethical theories. Stocker's paper is well known and often cited, yet moral schizophrenia remains a surprisingly obscure diagnosis. I argue that moral schizophrenia, properly understood, is not necessarily as disruptive as its name suggests. However, I also argue that Stocker's inability to demonstrate that moral schizophrenia constitutes a reductio of modern ethical theories does not rule out the (...) possibility that he has identified a noteworthy psychological phenomenon. Stocker is, in my opinion, correct to note that balancing our broad ethical obligations with authentic personal motives is a non-trivial psychological challenge, even if this challenge is not equivalent to a mental disorder. Hence, I conclude that proponents of modern ethical theorists should not be complacent about the burdens associated with implementing a moral psychology. (shrink)

The paper attempts to account for the confusion over the validity of the concept of schizophrenia in terms of two closely related aspects of conceptual indeterminacy. Firstly, it is identified on the basis of a breakdown in intelligibility, but what constitutes such a breakdown is indeterminate. Secondly, the concept sits between the categories of natural disease or illness on the one hand, and character trait or moral failing or gift on the other. This entails an indeterminacy in attempting to (...) define the role that physiological explanation could have. Light may be thrown on the concept by exploring a distinction between a life story in which the schizophrenic condition emerges as the conclusion of the story and a causal process in which the condition is the end result or final consequence. (shrink)

The concept of rational suicide argues that suicide could be a rational choice, in certain circumstances. Such an argument faces criticism when there is an accompanying mental illness, as many view suicide as a symptom of mental illness rather than as a rational choice about one's life. More specifically, the rational suicide debate has mostly excluded individuals with schizophrenia, as it is widely seen as a disorder that impairs rational decision making. This paper aims to examine the concept of (...) rational suicide in schizophrenia: Could it be possible that some acts of suicide are driven from a rational choice by patients suffering from schizophrenia? This paper does not include discussions related to physician-assisted dying in schizophrenia. (shrink)

Schizophrenia (SCZ) is a severe neurodevelopmental disorder affecting 1% of populations worldwide with a grave disability and socioeconomic burden. Current antipsychotic medications are effective treatments for positive symptoms, but poorly address negative symptoms and cognitive symptoms, warranting the development of better treatment options. Further understanding of SCZ pathogenesis is critical in these endeavors. Accumulating evidence has pointed to the role of mitochondria and metabolic dysregulation in SCZ pathogenesis. This review critically summarizes recent studies associating a compromised mitochondrial function with (...) people with SCZ, including postmortem studies, imaging studies, genetic studies, and induced pluripotent stem cell studies. This review also discusses animal models with mitochondrial dysfunction resulting in SCZ‐relevant neurobehavioral abnormalities, as well as restoration of mitochondrial function as potential therapeutic targets. Further understanding of mitochondrial dysfunction in SCZ may open the door to develop novel therapeutic strategies that can address the symptoms that cannot be adequately addressed by current antipsychotics alone. (shrink)

Merleau-Ponty finds a philosophical interest in the psychoanalytical clinic, especially in the the clinic of children and hallucinating people, which can support the concepts of flesh and Ineinander. But in the philosophy of Merleau-Ponty there is also a clinical interest, residing in the link he establishes between the flesh, conceived as the origin of existence, and the pathologies that Freud described as “narcissistic” and nowadays called “psychotic” or “borderline” states. To support this hypothesis, we will link Merleau-Ponty’s own “clinic of (...) the origins” and Harold Searles’ theory of narcissistic pathologies based on his clinical experience with schizophrenics. This confrontation will reveal how a philosophy of flesh provides us not only with theoretical points of reference relevant to the clinic of schizophrenia, but also fruitful technical indications regarding the direction towards a cure of such a pathology, indications that join those provided by Searles. (shrink)

This article examines the supposedly incomprehensibility of schizophrenic delusions. According to the contemporary classificatory systems (DSM-IV-TR and ICD-10), some delusions typically found in schizophrenia are considered bizarre and incomprehensible. The aim of this article is to discuss the notion of understanding that deems these delusions incomprehensible and to see if it is possible to comprehend these delusions if we apply another notion of understanding. First, I discuss the contemporary schizophrenia definitions and their inherent problems, and I argue that (...) the notion of incomprehensibility in these definitions rests heavily on Jaspers’ notions of understanding and empathy. Secondly, I discuss two Wittgensteinian attempts to comprehend bizarre delusions: (a) Campbell’s proposal to conceive delusions as framework propositions and (b) Sass’s suggestion to interpret delusions in the light of solipsism. Finally, I discuss the phenomenological conception of schizophrenia, which conceives delusion formation as resulting from alterations of the structure of experiencing and from underlying self-disorders. I argue that although a psychological understanding that seeks to grasp meaning in terms of motivations, desires, and other more straightforward psychological connections between mental states is impossible in schizophrenia, we can in fact have a philosophical understanding of the schizophrenic world and of the emergence of delusions typically found in schizophrenia. (shrink)

Scientists, philosophers, and even the lay public commonly accept that schizophrenia stems from a biological or internal ‘dysfunction.’ However, this assessment is typically accompanied neither by well-defined criteria for determining that something is dysfunctional nor empirical evidence that schizophrenia satisfies those criteria. In the following, a concept of biological function is developed and applied to a neurobiological model of schizophrenia. It concludes that current evidence does not warrant the claim that schizophrenia stems from a biological dysfunction, (...) and, in fact, that unusual neural structures associated with schizophrenia may have functional or adaptive significance. The fact that current evidence is ambivalent between these two possibilities (dysfunction versus adaptive function) implies that schizophrenia researchers should be much more cautious in using the ‘dysfunction’ label than they currently are. This has implications for both psychiatric treatment as well as public perception of mental disorders. (shrink)

Schizophrenia is characterised by marked language deficits, but it is not clear how these deficits arise from the alteration of genes related to the disease. The goal of this paper is to aid the bridging of the gap between genes and schizophrenia and, ultimately, give support to the view that the abnormal presentation of language in this condition is heavily rooted in the evolutionary processes that brought about modern language. To that end we will focus on how the (...) schizophrenic brain processes language and, particularly, on its distinctive oscillatory profile during language processing. Additionally, we will show that candidate genes for schizophrenia are overrepresented among the set of genes that are believed to be important for the evolution of the human faculty of language. These genes crucially include (and are related to) genes involved in brain rhythmicity. We will claim that this translational effort and the links we uncover may help develop an understanding of language evolution, along with the aetiology of schizophrenia, its clinical/linguistic profile, and its high prevalence among modern populations. (shrink)

This is a commentary on Humpston, C. S. (2022). “Isolated by Oneself: Ontologically Impossible Experiences in Schizophrenia.” Philosophy, Psychiatry, & Psychology 29(1), 5–15. It is published with an additional commentary by H. Green and Humpston’s response.

Despite the diagnostic relevance of thought insertion for disorders such as schizophrenia, the debates about its aetiology are far from resolved. This paper claims that in paying exclusive attention to the perceptual and cognitive impairments leading to delusional experiences in general, current deficit approaches overlook the role that affective disturbances might play in giving rise to cases of thought insertion. In the context of psychosis, affective impairments are often characterized as a consequence of the stress and anxiety caused by (...) delusional episodes. However, here I explore some of the conceptual and empirical reasons to think that affective problems might in fact play a crucial doxastic role in the aetiology of thought insertion. Finally, I conclude by proposing a way of integrating the main insights of my analysis with the current ‘two-factor’ deficit approach to thought insertion and I explore the potential adaptive role that some delusions might have within this framework. (shrink)