Minimal Self and Timing Disorders in Schizophrenia: A Case Report

Abstract

For years, phenomenological psychiatry has proposed that distortions of the temporal structure of consciousness contribute to the abnormal experiences described before schizophrenia emerges, and may relate to basic disturbances in consciousness of the self. However, considering that temporality refers mainly to an implicit aspect of our relationship with the world, disturbances in the temporal structure of consciousness remain difficult to access. Nonetheless, previous studies have shown a correlation between self disorders and the automatic ability to expect an event in time, suggesting timing is a key issue for the psychopathology of schizophrenia. Timing disorders may represent a target for cognitive remediation, but this requires that disorders can be demonstrated at an individual level. Since cognitive impairments in patients with schizophrenia are discrete, and there is no standardized timing exploration, we focused on timing impairments suggested to be related to self disorders. We present the case report of AF, a 22 year old man suffering from schizophrenia, with no antipsychotic intake. Although AF shows few positive and negative symptoms and has a normal neurocognitive assessment, he shows a high level of disturbance of Minimal Self Disorders (SDs) (assessed with the EASE scale). Moreover, AF has a rare ability to describe his self and time difficulties. An objective assessment of timing ability (variable foreperiod task) confirmed that AF had temporal impairments similar to those previously described in patients, i.e., a preserved ability to distinguish time intervals, but a difficulty to benefit from the passage of time to expect a visual stimulus. He presents additional difficulties in benefitting from temporal cues and adapting to changes in time delays. The impairments were ample enough to yield significant effects with analyses at the individual level. Although causal relationships between subjective and objective impairments cannot be established, the results show that exploring timing deficits at the individual level is possible in patients with schizophrenia. Besides, the results are consistent with hypotheses relating minimal self disorders (SDs) to timing difficulties. They suggest that both subjective and objective timing investigations should be developed further so that their use at an individual level can be generalized in clinical practice.

Temporal integration as “common currency” of brain and self‐scale‐free activity in resting‐stateEEGcorrelates with temporal delay effects on self‐relatedness

“…While both the physiological and psychological aspects of our body and the environment change continuously, our self is characterized by stability and endures nonetheless-the self thus provides temporal continuity over both short and long timescales (e.g., Ersner-Hershfield et al, 2009;Hershfield, 2011;Northoff, 2016Northoff, , 2017Schacter et al, 2012). The central importance of the temporal continuity of our self is further underlined by the fact that its disruption can lead to major alterations in our mental life, as manifested in psychiatric disorders like depression, mania, and psychosis or schizophrenia (Giersch & Mishara, 2017;Martin et al, 2014;Martin, Franck, Cermolacce, Coull, & Giersch, 2018;Martin, Giersch, Huron, & van Wassenhove, 2013;Northoff, 2007Northoff, , 2014Northoff, , 2016Northoff et al, 2017). Together, the self can be characterized by temporal continuity across different time scales-the self is not bound to a specific time scale but is scalefree (Huang, Obara, Davis IV, Pokorny, & Northoff, 2016;Wolff et al, 2019).…”

A reflection upon methods to explore timing in patients with schizophrenia

“…Time continuity is usually taken for granted. It is difficult to imagine time as being discontinuous, but this is precisely what seems to happen in patients with schizophrenia, who describe a fragmented consciousness flow, or an absence of time (Chapman, ; Fuchs, ; Martin, Franck, Cermolacce, Coull, & Giersch, ; Minkowski, ). Patients relate time fragmentation with disturbances of the sense of self, for example in the following:

Time splits up and doesn’t run forward anymore.

…”

“…Indeed, some people within the schizophrenia spectrum disorder have both a spontaneous interest in this question, and, on the other hand, sufficient elaboration capacities to try to conceptualize their own relation to time. Examples can be found in Minkowski (), Fuchs (), and Martin et al (). For example, the patient A.F.…”

“…For example, the patient A.F. (Martin et al, ) explained:

“I do not feel the time,” “The word ‘time’ has no meaning for me.” … “[I have to] use tools, tricks, to know that time has passed ... which does not mean much to me.” “For example, I often look at my watch to know that time has elapsed…” “You see, I can use a metaphor … Birds, they have a sense that allows them to orient themselves … a kind of magnetism … It is an innate thing … If they do not have it, they cannot navigate … Me, it's the time I do not have … I’m like blind to time … but I cannot explain it better … I try to find out how to talk about it … but I can’t manage to explain … It may be the most important thing to understand.” (Martin et al, , p. 3)

…”

Where Scizophrenia and Consciousness Intersect: Disorders of Consciousness in Schizophrenia

“…Subjective perception of time is a natural character of consciousness and is weakened in SCZ. Timing debilitations are believed to be identified with self-disorders (Martin et al, 2018). Irregularities of time recognition include time condensation and time prolongation and are experienced in SCZ.…”