Self-Disturbance and the Bizarre: On Incomprehensibility in Schizophrenic Delusions

Abstract

The notion of ‘bizarre delusion' has come into question in contemporary anglophone psychopathology. In DSM-5, it no longer serves as a special criterion for diagnosing schizophrenia nor as an exclusion criterion for delusional disorder. Empirical studies influencing this development have, however, been relatively sparse and subject to methodological criticism. Major reviews have concluded that current conceptualizations of bizarre delusions may require rethinking and refinement. Defining bizarreness entails a return to Jaspers, whose influential views on the supposed incomprehensibility of bizarre delusions and schizophrenic experience are more nuanced than is generally recognized. Jaspers insisted we must ‘get behind' three ‘external characteristics' (extraordinary conviction, imperviousness, impossible content) in order to acknowledge a ‘primary experience traceable to the illness' in the ‘delusions proper' of schizophrenia. He also denied that one could empathize with or otherwise ‘understand' this basis. Here, we focus on three features of bizarre delusions that Jaspers foregrounded as illustrating schizophrenic incomprehensibility: disturbance of the cogito, certitude combined with inconsequentiality, delusional mood. We link these with the contemporary ipseity disturbance model of schizophrenia, arguing that Jaspers' examples of incomprehensibility can be understood as manifestations of the three complementary aspects of ipseity-disturbance: diminished self-presence, hyperreflexivity and disturbed grip/hold. We follow Jaspers' lead in acknowledging a distinctive strangeness that defies ready comprehension, but we challenge the absolutism of Jaspers' skepticism by offering a phenomenological account that comprehends bizarreness in two ways: rendering it psychologically understandable, and fitting the various instances of bizarreness into a comprehensive explanatory framework.

Dreamlike effects of LSD on waking imagery in humans depend on serotonin 2A receptor activation

“…A recent study (Lebedev et al 2015) found that individual variability of psilocybin-induced psychedelic symptoms was best explained by a common factor that included vivid dreamlike imagery, loss of self-boundaries and fear of losing control over thought processes. Moreover, there is evidence that bizarreness in REM dreams of normal subjects (Fosse et al 2004) and in waking thoughts and dreams of schizophrenic patients (Rasmussen and Parnas 2015, Sass and Byrom 2015, Scarone et al 2008, Limosani et al 2011 is closely related to disturbed sense of self, and there is qualitative evidence that many bizarre features of both psychedelic imagery and dreams can be traced back to loss of self-boundaries and cognitive control (Pines 1976, Leuner 1968, Savage 1955, Abramson et al 1955. For example, one subject in the present study described loss of self-boundaries and cognitive control, and how closely this was related to bizarre imagery in the LSD condition as follows: "I merged with the environment.…”

Towards integrating phenomenology and neurocognition: Possible neurocognitive correlates of basic self-disturbance in schizophrenia

“…and Byrom [40] discuss ipseity disturbance's specific relevance for understanding the distinctively "bizarre" nature of delusions in schizophrenia (and elsewhere they speculate [41] about associated neurobiological factors that may contribute to self disorder as well as to the formation and maintenance of such delusions). [45] also reported no correlation between basic self-disturbance and neurocognitive measures in a first episode schizophrenia sample and a clinical high risk for psychosis sample, respectively.…”

A reflection upon methods to explore timing in patients with schizophrenia

“…Results from empirical studies using the EASE scale (Haug et al, ; Nelson, Thompson, & Yung, ; Nordgaard, Nilsson, Saebye, & Parnas, ; Raballo & Parnas, ; Raballo, Saebye, & Parnas, ) have now highlighted the high specificity of minimal‐self disorders in the schizophrenia spectrum, suggesting that minimal‐self disorders are trait markers of schizophrenia spectrum disorders (schizophrenia and schizotypal disorders). They would represent trait features that characterize the typical core of schizophrenia (Sass & Byrom, ).…”