Self-disorders and Psychopathology:A clinical-phenomenological exploration of schizophrenia spectrum disorders
Year: 2022
Type: book
Abstract: In the last two decades, empirical and theoretical work on self-disorders has attracted attention in research on schizophrenia spectrum disorders worldwide. Although the basic idea that schizophrenia fundamentally involves a disorder of the self is as old as the schizophrenia concept itself, empirical corroboration of this idea has been lacking for nearly a century. Moreover, contemporary research on self-disorders is confronted by several unsettled issues. The purpose of this dissertation was to explore and provide answers to some of these issues. More specifically, the dissertation i) explored the nature of self that is referred to in the concept of self-disorders, and how this self allegedly is disordered in schizophrenia spectrum disorders; ii) it reviewed the accumulating number of empirical studies, assessing if there is evidence to corroborate the hypothesis that self-disorders have diagnostic specificity for schizophrenia spectrum disorders; iii) it examined how the altered framework for experiencing oneself, others, and the world, epitomized by self-disorders, may affect other characteristic features of the psychopathology of schizophrenia such as poor insight into illness and psychosis; iv) it explored how self-disorders may shed new light on long-lasting social difficulties in schizophrenia spectrum disorders; and finally, v) the dissertation examined if and how self-disorders can be addressed in psychotherapy. Given the nature and diversity of these issues, different scientific methods were applied, including reviews of the empirical literature and, for the more theoretical, yet clinically informed inquiries, standard phenomenological methods. The dissertation found that the self that primarily is disturbed in schizophrenia spectrum disorders is the so-called ‘minimal self’, which designates the first-personal character of experience. Notably, a disorder at the level of the minimal self will also often cause problems at more advanced levels of selfhood such as personality or narrativity. It was argued that the minimal self is disordered in the sense of a frailty in the very first-personal manifestation of experience, and that this frailty manifests as a failing pre-reflective self-presence, causing an incomplete saturation of experiential life and enabling normally tacit aspects of mental life to emerge with alien or intrusive prominence in the midst of the patient’s own subjectivity. Moreover, a consistent hyper-aggregation of self-disorders in schizophrenia spectrum disorders were found in the two Reviews of the empirical literature, suggesting that self-disorders have a high degree of diagnostic specificity for the schizophrenia spectrum. However, self-disorders were not found to be exclusive or pathognomonic for the schizophrenia spectrum as they also occur in other mental disorders, though to a significant lesser extent. Furthermore, the dissertation offered a phenomenological reconsideration of key psychopathological features of the schizophrenia spectrum, including poor insight into illness, psychosis, and long-lasting social difficulties. Contrary to the understanding of poor insight into illness as an ineffective self-reflection, impeded either by primary defense mechanisms or metacognitive deficits, poor insight into illness was argued to be rooted in the nature of the patients’ self-disorders and the revelatory givenness of primary psychopathological phenomena. In regard to psychosis in schizophrenia, it was argued that it typically manifests as a form of double bookkeeping by which patients simultaneously exist in two different worlds, i.e., the shared-social world and a private-solipsistic and, at times, psychotic world. Crucially, these worlds are usually experienced as two different, non-conflicting realities, allowing them to co-exist and only occasionally to collide. This conception of psychosis as a form of double bookkeeping has implications for the traditional conceptualization of psychosis as gross impairment in reality testing, which consequently appears too narrow and thus inadequate to capture the full range of psychotic manifestations in schizophrenia. With regard to long-lasting social difficulties in the schizophrenia spectrum, we argued that these may be linked to self-disorders and that certain forms of social engagement appear to be particularly challenging, namely those that predominately are steered by the type of shared intentionality that we referred to as ‘we-intentionality’. Certain compensatory strategies to navigate the social world in schizophrenia spectrum disorders were also identified, and these seem mainly to be steered by another type of shared intentionality, viz. ‘joint intentionality’, which, by contrast, we argued remains unaffected in the schizophrenia spectrum disorders. Finally, insights were gathered from research on self-disorders in particular and phenomenological psychopathology more generally and formulated into concrete tools for a phenomenological informed psychotherapy of schizophrenia. The dissertation’s results and limitations were critically discussed, contextualized within the current research landscape, and new hypotheses and avenues for future research were presented.
Author: Henriksen, Mads Gram
Institutions: University of Copenhagen, Copenhagen University Hospital
Language: English
Topic: Mental Health and Psychiatry
Subfield: Philosophy
Field: Arts and Humanities
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W4412264702