European archives of psychiatry and clinical neuroscience
December 1, 2021
Josef Parnas, Annick Urfer-Parnas, Helene Stephensen
59 citations
People with schizophrenia can live in two separate worlds at once: the shared social world and a private delusional world. Eugen Bleuler called this "double bookkeeping" but never explained it. This article shows that double bookkeeping appears across many psychotic symptoms and can be observed before psychosis starts and in schizotypal disorder. The authors propose that double bookkeeping arises from instability in how the self feels itself from within, a process called auto-affection. They discuss four implications for diagnosis, understanding, treatment, and research into causes.
European archives of psychiatry and clinical neuroscience
September 1, 2024
Helene Stephensen, Annick Urfer-Parnas, Josef Parnas
28 citations
In schizophrenia, many patients experience a second, private reality alongside everyday shared reality, a phenomenon called double bookkeeping. In a qualitative study of 25 patients, most felt in contact with another dimension of reality that they considered more profound and real than the shared world. Hallucinations and delusions belonged to this separate reality, which patients usually kept distinct from ordinary life. This double reality persisted even during remission, and patients did not view their condition as an illness like a physical disease. Many described a vague sense of duality that began in childhood or early adolescence, tied to a fundamental alienation from self, world, and others.
Psychopathology
January 1, 2024
Helene Stephensen, Annick Urfer-Parnas, Josef Parnas
4 citations
Feeling fundamentally different from others (Anderssein) is a core but underexplored experience in schizophrenia spectrum disorders. Based on interviews with 25 patients, most reported having felt this way since childhood, often describing it as existing outside shared reality. Intersubjective reality felt unreal or inauthentic, while their inner world was invaded by alien thoughts, emotions, or social rules. The onset of psychosis involved a gradual extension of these altered structures of subjectivity. The authors conceptualize Anderssein as a halted dynamic movement between particularity and intersubjectivity, with critical implications for understanding schizophrenia's onset.
L'Encephale
August 1, 2025
Andreas Rosén Rasmussen, Helene Stephensen, Julie Nordgaard et al.
A French translation of the Examination of Anomalous Fantasy and Imagination (EAFI) is presented, along with an introduction to the phenomenology of imagination and its experiential alterations. The EAFI's interrater reliability was tested in a diagnostically heterogeneous sample of 20 inpatients, yielding agreement from 0.6 to 1.0 with an average κ of 0.84, and internal consistency (Cronbach's α) above 0.88. The anomalies of imagination explored by the EAFI are suggested to reflect an alteration of the structure of consciousness and belong to a fundamental, generative layer of psychopathology, with potential relevance for differential diagnosis, especially in first-contact patients.