Double bookkeeping and schizophrenia spectrum: divided unified phenomenal consciousness

Parnas, Josef; Urfer-Parnas, Annick; Stephensen, Helene

doi:10.1007/s00406-020-01185-0

Cited by 43 publications

(14 citation statements)

References 39 publications

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“…As a child, he felt as if he was not human and thematized this feeling of difference by fantasies of being extraterrestrial etc. This fundamental feeling of being different from others is a feeling of difference that precedes finding out what precisely it is that is different and which in psychiatry has been called a feeling of “Anderssein” [ 30 ]. In other words, the patient experiences an ineffable difference that is located at the pre-predicative level.…”

Section: Results (Clinical Vignettes)mentioning

confidence: 99%

Disorder of Selfhood in Schizophrenia: A Symptom or a Gestalt?

2022

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Introduction: The concept of schizophrenia (SCZ) was originally associated with a disorder of formal strata of the self. During the last two decades, empirical studies have demonstrated a selective hyper-aggregation of self-disorders in the SCZ spectrum. As with other scientific research areas, the role of self-disturbances in SCZ has been up for debate in various disciplines including cognitive sciences, philosophy of mind, and psychopathology. Several philosophical papers have used the psychopathological phenomena of “thought insertion” as an alleged example of a complete loss of minimal selfhood. In the field of psychopathology, it has been claimed that self-disorders may comprise a transdiagnostic phenotype. Common to these approaches is the underlying assumption that self-disorders reflect well-delineated and isolated symptoms akin to the notion of symptom in the medical model. The aim of this paper was to argue that the clinical manifestation of self-disturbances is to be seen as aspects of a Gestalt of disturbed experiential selfhood. Methods: Seven videotaped interviews of patients with SCZ who were emblematic of very diverse symptomatological constellations were selected and jointly watched and discussed by the authors, who reached a consensus assessment. The interviews were semi-structured and narrative in nature in order to obtain faithful self-descriptions according to the standards of phenomenologically oriented interviews. For the purpose of this article, we chose 4 videos from which excerpts were verbatim transcribed and translated from Danish into English. Results: The patients describe unique combinations of various psychopathological phenomena such as diminished sense of embodied self-presence, loss of ego boundaries, diminished sense of self, alienation and objectification of the experiential processes, mirror-phenomena, and Schneiderian passivity phenomena. Discussion: Through an interweaving of the four vignettes and their subsequent psychopathological discussions, we argue that the invariant commonality across the different symptomatic expressions in these patients resides in a Gestalt of pervasive disturbance of self-experience. From a phenomenological perspective, these self-disturbances target a basic structure of phenomenal consciousness, namely, the first-person givenness of experience. We conclude that self-disorders reflect a trait-instability in the most basic structures of consciousness in SCZ and that its clinical manifestations are to be seen as aspects of a particular Gestalt rather than appearing as separate and well-delineated symptoms.

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Section: Results (Clinical Vignettes)mentioning

confidence: 99%

Disorder of Selfhood in Schizophrenia: A Symptom or a Gestalt?

2022

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“…A scale intended to explore disorders of imagination has also been published [50]. Other psychopathological domains inspired by self-disorder research comprise investigations into the nature of insight into illness in schizophrenia [51], the condition of double bookkeeping [52], and disorders of introspection [53]. Currently, a work is in progress concerning the phenomenology of auditory verbal hallucinations and their potential route in the instability of selfhood [54].…”

Section: Resultsmentioning

confidence: 99%

Disordered Selfhood in Schizophrenia and the Examination of Anomalous Self-Experience: Accumulated Evidence and Experience

et al. 2021

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Disordered selfhood in schizophrenia was rediscovered at the turn of the millennium. In 2005, Psychopathology published the psychometric instrument, the Examination of Anomalous Self-Experience (EASE). In this article, we summarize the historical background of the creation of the EASE, explicate the notion of the disorder of basic or minimal self with the help of phenomenological philosophy, and provide a brief description of clinical manifestations targeted by the EASE. We also present our personal experience using and teaching the EASE and summarize the empirical evidence obtained so far. We conclude that the basic self-disorder represents a crucial phenotype of schizophrenia spectrum disorders and that this phenotype offers a potential avenue to empirical pathogenetic research and psychotherapeutic treatment.

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“…It is characteristic that the patient lives in a simultaneous double reality (the phenomenon of double book-keeping). One reality is our shared social world, whereas the other with an apodictic epistemic status is a private reality ungoverned by the natural and conventional axioms of causality and time ( Henriksen and Parnas, 2014 ; Parnas and Henriksen, 2016 ; Parnas et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Auditory Verbal Hallucinations in Schizophrenia, Part II

2022

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Hallucination is defined in the diagnostic systems as an experience resembling true perception without causal stimulus. In this second report from an in-depth phenomenological study of schizophrenia patients experiencing auditory verbal hallucinations (AVHs), we focused on the phenomenological qualities of AVHs. We found that a substantial proportion of patients could not clearly distinguish between thinking and hallucinating. The emotional tone of the voices increased in negativity. AVHs became more complex. Spatial localization was ambiguous and only 10% experienced only external hallucinations. There was an overlap with passivity phenomena in one third of the cases. The patients occasionally acted upon the content of AVHs. In the discussion section, we criticize the perceptual model of AVHs. We conclude that the definition of AVH in schizophrenia is misleading and exerts negative consequences on the clinical work and empirical research.

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Double bookkeeping and schizophrenia spectrum: divided unified phenomenal consciousness

Cited by 43 publications

References 39 publications

Disorder of Selfhood in Schizophrenia: A Symptom or a Gestalt?

Disorder of Selfhood in Schizophrenia: A Symptom or a Gestalt?

Disordered Selfhood in Schizophrenia and the Examination of Anomalous Self-Experience: Accumulated Evidence and Experience

Auditory Verbal Hallucinations in Schizophrenia, Part II

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