In Recovery from Schizophrenia: Regaining Social Cover – A Phenomenological Investigation

Abstract

We offer here a framework for the understanding of being in recovery from schizophrenia as an interpersonal process. We draw upon in-depth phenomenological descriptions of the fundamental changes taking place in an individual’s mental life when they are suffering from schizophrenia. There is a loss of commonsensical habituality and interpersonal capabilities, usually most prominently expressed as an impaired intersubjective resonance. People with schizophrenia cannot as easily automatically and coherently display their own emotion via their facial expressions or perceive those of others, as do ‘normal’ people. This implies that interpersonal resonance between interacting individuals is not automatic, as is often taken for granted. The need to actively rebuild interpersonal resonance also holds true for the interacting ‘normal’ person, but would be an unfamiliar and unexpected task. These difficulties in empathizing provoke a mismatch in interpersonal resonance, often leading to the intuition that the person having schizophrenia lacks (explicit) self-awareness. We conclude that there is a mismatch in the form and scope of the social cover extended to the social role opportunities available in trans-Atlantic cultural settings for people with schizophrenia. Typically, these social roles imply that people with schizophrenia are unaware of themselves; however, while they often lack insight or may not consider their symptoms as signs of a mental disorder, they are usually not ‘confused’ or ‘distracted’ in the sense of no longer being aware of themselves. We discuss various options for adequate social cover achievable for people with schizophrenia, demonstrating their impact on the recovery process.

Schizophrenia and the Other: A Phenomenological Approach to ‘Positive Withdrawal'

“…Fuchs and Schlimme [24] argue that the sense of self is bound up with the sense of Others, and that disembodiment of self and disturbance of intercorporality mutually influence each other, and result in, to borrow the words of Blankenburg, a ‘loss of natural self-evidence'. In accordance with this theory, Schlimme and Schwartz [25] argue that lack of social cover is a major part of the subjective experience of schizophrenia and that, in psychotherapy, providing and maintaining social cover is not just a goal to strive for but a method to reach the therapeutic goals.…”

The Phenomenology of Intersubjectivity in Jaspers and Husserl: On the Capacities and Limits of Empathy and Communication in Psychiatric Praxis

“…playing guitar in the gardens, having a coffee in the students' café, or using a piano in the café run by psychiatric outpatients). It was nearly impossible to immediately feel what he felt, as is typically the case with persons who have schizophrenia [1,9]. This did not imply that he was emotionally uninvolved, but that his facial expressions were highly and specifically impaired to automatically display his feelings, emotions, or moods (this is a typical impairment in persons with schizophrenia [10,11]).…”

“…Considering these insights, we can conclude that there is an impaired intersubjective resonance, or empathizing, between persons with and without schizophrenia from both sides: an impaired possibility to read the face of the afflicted, and an impaired ability of the afflicted to read the faces of the others. This impaired resonance has, of course, a crucial impact on recovering from schizophrenia [1]. …”

“…We will also discuss the important issue of the possibility of empathy with what Husserl calls ‘abnormal' people. While Husserl has theoretical doubts whether such empathy with persons with mental illnesses is possible, the fact of at least some minimal empathizing in such encounters cannot be denied [1]. Moreover, while Husserl offers a plethora of descriptive analyses concerning this phenomenon, his account, as does Jaspers', suffers a significant shortcoming.…”

“…The classical example for this impairment would be stigma, typically accompanied with the assumption that the poorly empathized other is more like an animal or a child, having no self-conscious mental states of his own [1]. …”