Self-disturbances in Schizophrenia: History, Phenomenology, and Relevant Findings From Research on Metacognition

Abstract

With a tradition of examining self-disturbances (Ichstörungen) in schizophrenia, phenomenological psychiatry studies the person's subjective experience without imposing theoretical agenda on what is reported. Although this tradition offers promising interface with current neurobiological models of schizophrenia, both the concept of Ichstörung and its history are not well understood. In this article, we discuss the meaning of Ichstörung, the role it played in the development of the concept of schizophrenia, and recent research on metacognition that allows for the quantitative study of the link between self-disturbance and outcome in schizophrenia. Phenomenological psychiatrists such as Blankenburg, Binswanger, and Conrad interpreted the Ichstörung as disturbed relationship to self and others, thus challenging recent efforts to interpret self-disturbance as diminished pure passive self-affection, which putatively "explains" schizophrenia and its various symptoms. Narrative is a reflective, embodied process, which requires a dynamic shifting of perspectives which, when compromised, may reflect disrupted binding of the components of self-experience. The Metacognition Assessment Scale-abbreviated as MAS-A-suggests that persons with schizophrenia tend to produce narratives with reductions in the binding processes required to produce an integrated, embodied self within narrated life stories, and in interactive relationships with others.

Consciousness, awareness of insight and neural mechanisms of schizophrenia

“…In this context, the human mind represents the form that influences brain and body, which has significant implications for psychotherapy that specifically may support self-awareness and insight representing metacognitive abilities as was reported in various studies (Lysaker et al, 2003(Lysaker et al, , 2010(Lysaker et al, , 2013Mishara et al, 2014) and directly affect neural mechanisms of schizophrenia through influences of conscious integration on integrative neural mechanisms (Baars, 2002;Bob and Mashour, 2011).…”

“…According to recent research, disturbances of self-awareness and conscious experience have a critical role in the pathophysiology of schizophrenia, and in this context, schizophrenia is currently understood as a disorder characterized by distortions of the acts of awareness, self-consciousness, and self-monitoring (Frith, 1987;Gallagher, 2000;Kircher and Leube, 2003;Lou, 2012;Mishara et al, 2014).…”

“…This neurocognitive concept of insight is also closely associated with the Theory of Mind, defined as ability to understand the mental states of others (Frith, 1992;Sprong et al, 2007;Bora et al, 2009;Lysaker et al, 2010) corresponding to recent understanding of schizophrenia as a disorder of self-awareness and conscious experience (Ford et al, 2007;Mishara, 2007;Uhlhaas and Mishara, 2007;Lysaker et al, 2010;Lou, 2012;Mishara et al, 2014). Taken together, these data indicate that typical insight deficits in schizophrenia most likely are closely linked to disturbances in neural mechanisms of consciousness.…”

“…The concept of insight in its relationship to mental disorders was proposed in the late 19th century and was closely linked to the first-person perspective of viewing and understanding one's own mental state that became crucial for diagnosis (Amador at al., 1991;Markova and Berrios, 1995;Lysaker et al, 2013;Mishara et al, 2014). For example, in Gestalt psychology, the moment when a person suddenly experiences the so-called 'aha!'…”

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

“…Mishara et al [26] directly criticize the ipseity approach, arguing that appealing to an irrelational and nonreflexive self (the ipseity) to explain the pathology of schizophrenia is unscientific in as far as no testable hypotheses can be deduced from this theory. Instead, they maintain that a theory appealing to a disturbance of the relational self, that is, the self who, in some way or form, is in a relation to the world and to other people, is a far more fruitful theory.…”