The phenomenological nature of schizophrenia and disorder of selfhood.

Summary

Schizophrenia's underlying causes remain poorly understood, partly because its characteristic overall pattern (Gestalt) has been neglected. This article argues that disturbances in the sense of self are central to this pattern. It first outlines a phenomenological theory of selfhood, then describes early complaints in schizophrenia that reflect a disordered self, often traceable to childhood. Key psychotic features—hallucinations, delusions, and double bookkeeping—are linked to self-instability. The encounter with patients also reveals self-disorders, which aid diagnosis. The authors conclude that phenomenology is essential for psychiatric research.

Study at a glance

Abstract

Schizophrenia continues its resistance to the pathogenetic understanding. We believe that one of the reasons is an oblivion of schizophrenia's characteristic Gestalt expressive of its psychopathological structure. In this article we argue for a crucial role of disorders of selfhood in the constitution of this Gestalt. First, we present a phenomenological account of the self. This is followed by an exposition of basic complaints in schizophrenia which are reflective of a disordered selfhood and which often date back to childhood. We then present characteristic features of the schizophrenic psychosis with its phenomenon of "double bookkeeping". Hallucinations, delusions and double bookkeeping are all associated with the instability of the self. Finally, we briefly address characteristic aspects of the encounter with a schizophrenia patient and argue that self-disorders play an important diagnostic role. We conclude by emphasizing the role of phenomenology in psychiatric research.

Tags