Anomalies of Imagination and Disordered Self in Schizophrenia Spectrum Disorders.

Summary

In schizophrenia spectrum disorders, mental imagery can become unusually vivid and take on quasi-perceptual qualities, such as spatialization, constancy, and autonomy, often provoking intense emotional responses and blurring the normal sense of unreality. This phenomenon, termed perceptualized imagery, arises from a deeper disturbance in the minimal self (unstable first-person perspective). Recognizing these anomalies aids early and differential diagnosis, distinguishing schizophrenia from other disorders with overlapping symptoms like obsessions or ruminations.

Study at a glance

Abstract

Vivid mental imagery occurs frequently in schizophrenia spectrum disorders (SSDs). Overlapping phenomena, such as obsessions or ruminations, are also frequent in other psychiatric disorders, raising significant diagnostic challenges. Unfortunately, contemporary operational psychopathology lacks the epistemological and phenomenological framework to address such questions. Using the resources of phenomenology and philosophy of mind, we articulate the structure of imagination and describe its distinctive modifications in the SSDs. Drawing on pilot data with patients' self-descriptions, we present the notion of perceptualized imagery. The anomalous imagery acquires spatialization, spatiotemporal constancy, explorability, autonomy and a sense of experiential distance between the subject and the image. As a quasi-perceptual, stable object, such imagery often evokes an intense affective response, whereas the normal sense of 'irreality' of the fantasy may become compromised. We articulate these anomalies of imagination as being entailed by the underlying generative disorder of schizophrenia, namely the disorder of minimal self (unstable ipseity or first-person perspective). We propose that pathology of imagination is an important psychopathological aspect of the schizophrenia spectrum, with significant relevance for early diagnosis and differential diagnosis.