Phenomenology and neurobiology of self disorder in schizophrenia: Secondary factors.
Schizophrenia research December 1, 2015 Peer reviewed DOI: 10.1016/j.schres.2015.09.025 via PubMed
Summary
Schizophrenia involves disturbances in basic self-experience, or ipseity. This paper describes secondary phenomenological alterations that arise from more primary disruptions in perceptual integration. These secondary features include hyperreflexivity, diminished self-presence, and a disturbed grip on awareness. They can be understood as defensive or compensatory reactions, shaped by attention and meta-awareness. Such alterations may become more pronounced in adolescence due to prefrontal lobe development. Their variability may explain much of the clinical diversity in schizophrenia, both between patients and within individuals over time, while still pointing to shared underlying disturbances.
Study at a glance
| Design | theoretical or philosophical paper |
|---|---|
| Key finding | Secondary phenomenological alterations in schizophrenia—hyperreflexivity, diminished self-presence, and disturbed grip on awareness—are compensatory or downstream effects of primary perceptual dys-integration and may account for clinical heterogeneity. |
Abstract
Schizophrenia is a diverse and varying syndrome that defies most attempts at classification and pathogenetic explanation. This is the second of two articles offering a comprehensive model meant to integrate an understanding of schizophrenia-related forms of subjectivity, especially anomalous core-self experience (disturbed ipseity), with neurocognitive and neurodevelopmental findings. Previously we discussed the primary or foundational role of disturbed intermodal perceptional integration ("perceptual dys-integration"). Here we discuss phenomenological alterations that can be considered secondary in a pathogenetic sense--whether as consequential products downstream from a more originary disruption, or as defensive reactions involving quasi-intentional or even volitional compensations to the more primary disruptions. These include secondary forms of: 1, hyperreflexivity, 2, diminished self-presence (self-affection), and 3. disturbed "rip" or "hold" on the cognitive/perceptual field of awareness. We consider complementary relations between these secondary abnormal experiences while also considering their temporal relationships and pathogenetic intertwining with the more primary phenomenological alterations discussed previously, all in relation to the neurodevelopmental model. The secondary phenomena can be understood as highly variable factors involving overall orientations or attitudes toward experience; they have some affinities with experiences of meditation, introspectionism, and depersonalization defense. Also, they seem likely to become more pronounced during adolescence as a result of new cognitive capacities related to development of the prefrontal lobes, especially attention allocation, executive functions, abstraction, and meta-awareness. Heterogeneity in these secondary alterations might help explain much of the clinical diversity in schizophrenia, both between patients and within individual patients over time--without however losing sight of key underlying commonalities.