Objective: Basic temporal dysfunctions have been described in patients with schizophrenia, which may impact their ability to connect and synchronize with the outer world. The present study was conducted with the aim to distinguish between interval timing and synchronization difficulties and more generally the spatial-temporal organization disturbances for voluntary actions. A new sensorimotor synchronization task was developed to test these abilities. Method: Twenty-four chronic schizophrenia patients matched with 27 controls performed a spatial-tapping task in which finger taps were to be (...) produced in synchrony with a regular metronome to six visual targets presented around a virtual circle on a tactile screen. Isochronous (time intervals of 500 ms) and non-isochronous auditory sequences (alternated time intervals of 300/600 ms) were presented. The capacity to produce time intervals accurately versus the ability to synchronize own actions (tap) with external events (tone) were measured. Results: Patients with schizophrenia were able to produce the tapping patterns of both isochronous and non-isochronous auditory sequences as accurately as controls producing inter-response intervals close to the expected interval of 500 and 900 ms, respectively. However, the synchronization performances revealed significantly more positive asynchrony means (but similar variances) in the patient group than in the control group for both types of auditory sequences. Conclusion: The patterns of results suggest that patients with schizophrenia are able to perceive and produce both simple and complex sequences of time intervals but are impaired in the ability to synchronize their actions with external events. These findings suggest a specific deficit in predictive timing, which may be at the core of early symptoms previously described in schizophrenia. (shrink)

We present a conceptual framework on the experience of time and provide a coherent basis on which to base further inquiries into qualitative approaches concerning time experience. We propose two Time-Layers and two Time-Formats forming four Time-Domains. Micro-Flow and Micro-Structure represent the implicit phenomenal basis, from which the explicit experiences of Macro-Flow and Macro-Structure emerge. Complementary to this theoretical proposal, we present empirical results from qualitative content analysis obtained from 25 healthy participants. The data essentially corroborate the theoretical proposal. With (...) respect to Flow, the phenomenally accessible time experience appeared as a continuous passage reaching from the past through the present into the future. With respect to Structure, the individual present was embedded in the individual biography, emerging from past experiences and comprising individual plans and goals. New or changing plans and goals were being integrated into the existing present, thus forming a new present. The future appeared as changeable within the present, by means from the past, and therefore as a space of potential opportunities. Exemplarily, we discuss these results in relation to previous empirical findings on deviant experiences of time in Autism Spectrum Disorder that is presumably characterized by a breakdown of Flow and concomitant compensatory repetition resulting in an overly structured time. Finally, we speculate about possible implications of these findings both for psychopathological and neuroscientific research. (shrink)

This current study is a pilot project designed to clarify changes in the lived world among people with diagnoses within the schizophrenia spectrum. The Examination of Anomalous World Experience was used to interview ten participants with schizophrenia spectrum disorders and a comparison group of three participants with major depressive disorder. Interviews were analyzed using the descriptive phenomenological method. This analysis revealed two complementary forms of experience unique toszparticipants: Destabilization, the experience that reality and the intersubjective world are less comprehensible, less (...) stable, and generally less real; and Subjectivization, the dominance of one’s internal, subjective experiences in the perception or interpretation of the lived world. Persons with depressive disorders, by contrast, did not experience disruptions of the reality or independence of the world or any significant disruptions of appearance or meaning. These results are consistent with contemporary and classic phenomenological views on anomalous world experience in schizophrenia. (shrink)

The DSM characterizes major depressive disorder partly in temporal terms: the depressive mood must last for at least two weeks, and also must impact the subject "most of the day, nearly every day." However, from the standpoint of phenomenological psychopathology, the long-lasting quality of the condition hardly captures the distinctiveness of depression. While the DSM refers to objective time as measured by clocks and calendars, what is especially striking about depression is the distortions to lived time that it involves. But (...) is there any relation between a) these disruptions to temporal experience and b) the tendency for depressive symptoms to persist and endure? To explore the connection between lived time and objective time, I investigate the embodied and enactive nature of intentionality among subjects suffering from depression. What I call 'affective framing' is a spontaneous, pre-reflective way of filtering information that involves bodily attunement and allows subjects to focus their attention on what they feel is important. I will argue that affective framing ordinarily has a forward-looking temporal structure and a "teleological direction" that is rooted in our embodiment. However, depression involves a distortion in future-directed intentionality, so that a subject becomes temporally desituated and cut off from the future. This contributes to many of the characteristic features of depression, including apparent lack of motivation, inability to imagine future possibilities, alterations in lived time, and a sense that one is "stuck." To gain a better understanding of this disruption to the futuredirected structure of affective framing in cases of depression, I look to concepts from complex dynamic systems theory and the notion of 'habit.' My proposed account aims to shed light on how a disruption to future-directedness impacts bodily attunement and reinforces depression as a long-term condition. (shrink)

Decades ago, several authors have proposed that disorders in automatic processing lead to intrusive symptoms or abnormal contents in the consciousness of people with schizophrenia. However, since then, studies have mainly highlighted difficulties in patients’ conscious experiencing and processing but rarely explored how unconscious and conscious mechanisms may interact in producing this experience. We report three lines of research, focusing on the processing of spatial frequencies, unpleasant information, and time-event structure that suggest that impairments occur at both the unconscious and (...) conscious level.We argue that focusing on unconscious, physiological and automatic processing of information in patients, while contrasting that processing with conscious processing, is a first required step before understanding how distortions or other impairments emerge at the conscious level. We then indicate that the phenomenological tradition of psychiatry supports a similar claim and provides a theoretical framework helping to understand the relationship between the impairments and clinical symptoms. We base our argument on the presence of disorders in the minimal self in patients with schizophrenia. The minimal self is tacit and non-verbal and refers to the sense of bodily presence. We argue this sense is shaped by unconscious processes, whose alteration may thus affect the feeling of being a unique individual. This justifies a focus on unconscious mechanisms and a distinction from those associated with consciousness. (shrink)

This dissertation combines two scientific disciplines and research fields, namely philosophy and psychopathology. Within such a wide field of investigation, two precise perspectives are to be adopted in this inquiry: stemming from the first field, the phenomenological perspective on subjectivity and intersubjectivity; stemming from the second, the psychopathological perspective on schizophrenia. The combination of philosophy and psychopathology has often proven fruitful. Moreover, the main motivation for such combined approach is justified by the strong belief that, when critically used, phenomenology offers (...) a viable method of studying the first-personal perspective of experience, including the experiences of people with mental disorders. Philosophical analysis can thereby be used as a means to evaluate the meaning and adequacy of psychopathological concepts and ideas. As a result, phenomenological psychopathology may help understand what is often claimed to be incomprehensible. Particularly for the understanding of schizophrenia, this is taken to be a valuable contribution. For more than twenty years now, the phenomenological approach to schizophrenia has developed a strong and influential hypothesis on the basic alterations of this disorder. Schizophrenia, it is claimed, is a disorder of subjectivity, and more specifically, a disorder of the minimal self. Simultaneously, and often in conjunction, philosophical research on the self has vastly proliferated. The vivid interaction between these two fields makes the phenomenology of schizophrenia a good example of effective interdisciplinary work. Within the philosophical debate on subjectivity, intersubjectivity, or the relation between self and other, is currently a key topic. However, this has not significantly influenced the psychopathology of schizophrenia yet. The initial and fundamental claim of this dissertation is indeed that a renewed evaluation and inclusion of intersubjectivity, next to subjectivity, is to increase the validity of the phenomenological approach to schizophrenia. This would allow the previous hypothesis on schizophrenia as minimal self disorder to be challenged, criticized, or complemented, which would accordingly increase the significance and its clinical value. What I will attempt to do in this dissertation is then to thoroughly evaluate the role of intersubjectivity in schizophrenia. It will hence become clear what this role and its significance are. Consequently, I will finally argue that the basic alterations of schizophrenia concern both subjectivity and intersubjectivity. My argument is developed in four chapters. In the first, I introduce the topic of the self, including the distinction between the minimal and the extended self. This chapter equally introduces schizophrenia as a psychiatric concept, and three different clinical approaches are discussed, among which the phenomenological approach in most detail. After the topics of the self and schizophrenia, I introduce intersubjectivity, notably from a developmental-psychological perspective. By way of status quaestionis, I recapitulate the current research on intersubjectivity and schizophrenia. It will become clear that this research is relatively scarce. I then conclude the chapter with a full formulation of the two research questions informing this dissertation, namely Is schizophrenia an intersubjectivity-disorder? and Which self-concept is suited to define schizophrenia as a self and intersubjectivity disorder? The second chapter examines the phenomenology of intersubjectivity. The exact delineation of what is meant here by intersubjectivity will allow the reader to acknowledge its extent and variety. This chapter is aimed to provide the necessary philosophical tools to analyse schizophrenia in the light of intersubjectivity. In the third chapter I turn to psychopathology. In the first section, I analyse the work of seven major psychopathologists on schizophrenia. The goal of this section is to look for elements of intersubjectivity in their accounts of schizophrenia. Many of these psychopathologists have been influential for the development of the current self-disorder hypothesis, and the investigation intends to show how some crucial intersubjective elements in their work have been neglected. In the second section of this chapter, I focus on the symptoms, signs, and phenomena of schizophrenia that relate to intersubjectivity. This chapter finally offers all the material needed to positively answer the first research question. In the fourth chapter, I bring together psychopathology and philosophy, and I attempt to answer the two research questions. Since Chapter 3 allows me to affirmatively answer the first question, I examine whether the current self-disorder hypothesis is adequate to integrate intersubjectivity disturbances. It will appear that it is not, and the first section of this chapter consequently deals with the question why intersubjectivity and its disturbances have been neglected until now. In the second section it will become clear that no different self-concept is required, but that schizophrenia primarily concerns a particular capacity or orientation of subjectivity. I introduce the concept of open subjectivity and thereby answer the second research question. By describing schizophrenia as a disturbance of open subjectivity, I am finally able to integrate both self-disturbances and intersubjectivity-disturbances into a coherent and unified theory. To conclude this dissertation, I summarize and recapitulate its major issues, questions, and results in Chapter 5. Both clinical implications and possible future research are also discussed here. (shrink)

The article covers Erwin W. Straus’ views on the problem of time and temporal experience in the context of psychopathology. Beside Straus’ published scholarship, including his papers dealing exclusively with the subject of time, the sources utilized in this essay comprise several of Straus’ unpublished manuscripts on temporality, with the primary focus on the 1952 manuscript Temporal Horizons, which is discussed in greater detail and subsequently published for the first time in this journal. In the first part of the article, (...) the author introduces what he considers to be the central tension of the whole of Straus’ work on the issue of time, namely, the tension stemming from a dualistic account of time with its personal and impersonal dimensions. Interpretative developments of this tension are followed covering Straus’ early German works and his late American scholarship. The author presents Straus’ way of overcoming the dualistic account of time and his arguments in favour of what is termed here the “unified view of time”. Of critical importance for the unified view is Straus’ concept of “today”, which is extensively commented upon. In the second part of the article, the author focuses on the psychopathological consequences of the unified view as seen by Straus. A clear-cut boundary between a normal and a psychotic experience of time is supposed to lie in breaking the bond between the personal and the impersonal orders of time, leading to a fundamental estrangement. This view, it is claimed, is already present in a nutshell in Straus’ earliest work, and is elaborated upon later. In conclusion, both the merits and the weaknesses of Straus’ account of temporality are presented. A major advantage is that Straus abstains from a dualistic conception of time and reappraises the often-devalued clock time. A fundamental drawback is that Straus does not venture to explore the pathological varieties of temporal experience and fails to specify the acknowledged differences between, on the one hand, psychotic elements in depressive disorders, and, on the other hand, such elements in schizophrenic disturbances. (shrink)

Several philosophers have recently argued that phenomenology is well-suited to help understand the concepts of health, disease, and illness. The general claim is that by better analysing how illness appears to or is experienced by ill individuals—incorporating the first-person perspective—some limitations of what is seen as the currently dominant third-person or ‘naturalistic’ approaches to understand health and disease can be overcome. In this article, after discussing some of the main insights and benefits of the phenomenological approach, I develop three general (...) critiques of it. First, I show that what is often referred to as naturalism tends to be misunderstood and/or misrepresented, resulting in straw-man arguments. Second, the concept of normality is often problematically employed such that some aspects of naturalism are actually presupposed by many phenomenologists of medicine. Third, several of the key phenomenological insights and concepts, e.g. having vs. being a body, the alienation of illness, the epistemic role of the first-person perspective, and the idea of health within illness, each bring with them new problems that limit their utility. While acknowledging the possible contributions of phenomenology, these criticisms point to some severe limitations of bringing phenomenological insights to bear on the problems facing philosophy of medicine that should be addressed if phenomenology is to add anything substantially new to its debates. (shrink)

Here we consider interpersonal experience in schizophrenia, melancholia, and mania. Our goal is to improve understanding of similarities and differences in how other people can be experienced in these disorders, through a review of first-person accounts and case examples and of contemporary and classic literature on the phenomenology of these disorders. We adopt a tripartite/dialectical structure: first we explore main differences as traditionally described; next we consider how the disorders may resemble each other; finally we discuss more subtle but perhaps (...) foundational ways in which the phenomenology of these disorders may nonetheless be differentiated. These involve disruptions of common sense and conventionality, abnormalities of empathy, distinct forms of paranoia and the sense of personal centrality, and altered perceptions of intentionality, deadness, and artificiality. We end by considering some neurocognitive research relevant to these abnormal forms of subjectivity, including work on theory of mind, experience of human movement, and perception of faces. (shrink)

We report on an interview-based study of decision-making capacity in two classes of patients suffering from depression. Developing a method of second-person hermeneutic phenomenology, we articulate the distinctive combination of temporal agility and temporal inability characteristic of the experience of severely depressed patients. We argue that a cluster of decision-specific temporal abilities is a critical element of decision-making capacity, and we show that loss of these abilities is a risk factor distinguishing severely depressed patients from mildly/moderately depressed patients. We explore (...) the legal and clinical consequences of this result. (shrink)

This paper explores the question concerning the relationship between basic and higher layers of experience and self-experience. The latter distinction implicitly presupposes the idea of a univocal foundation. After explaining the formal ontological law of foundation, an attempt is made to clarify how the idea of foundation may be suitable to understand the relationship among moments, or layers, of self-experience. To this aim, the phenomenological descriptions of self- and world-experience in dementia and schizophrenia are compared. The comparison between these two, (...) in many ways radically different, pathologies allows us to highlight both the potentialities and the limits of resorting to the foundational relationship for the description of lived experience. Taking the challenges coming from the description of dementia and schizophrenia into serious consideration, the meaning of the “stratified” account of self-experience will be eventually reassessed, and a way to complement the idea of foundation among layers will be proposed. (shrink)

Abstract This paper proposes that adopting a ?phenomenological stance? enables a distinctive kind of empathy, which is required in order to understand forms of experience that occur in psychiatric illness and elsewhere. For the most part, we interpret other people's experiences against the backdrop of a shared world. Hence our attempts to appreciate interpersonal differences do not call into question a deeper level of commonality. A phenomenological stance involves suspending our habitual acceptance of that world. It thus allows us to (...) contemplate the possibility of structurally different ways of ?finding oneself in the world?. Such a stance, I suggest, can be incorporated into an empathetic appreciation of others' experiences, amounting to what we might call ?radical empathy? (shrink)

There is a paradox that lies at the heart of every investigation of normality, namely, its dependence on its other (e.g., deviation, break, difference). In this paper, I want to show that this paradox is the reason for the dynamism as well as fragility of normality. In this regard, I will not only argue that every normality is fragile, but also that normality can only be established because it is fragile. In the first part of this paper, I will present (...) and re-visit Husserl’s account of normality as concordant and optimal with regard to its dynamic or fragile aspects. In the second part of this paper, I will apply this account to recent findings in phenomenological pathology regarding schizophrenia and depression to show how Husserl’s account could be helpful for differentiating between different aspects (such as concordance and optimality) as well as genetic levels of (disturbances of) normality. (shrink)

This article explores the idea that there is a spectrum of individuals who feel compelled to dwell in the past, either due to psychological or social conditions. I analyze both conditions respectively by critically examining two cases: post-traumatic stress disorder and racialized oppression. I propose that individuals with PTSD can feel psychologically compelled to dwell in the past in a dually negative sense: the individual lives in the past but also broods on it, causing them to feel “stuck” in the (...) past. This kind of “dwelling” can cause individuals to suffer disruptions to their sense of self and intersubjectivity. After exploring the psychological case of dwelling in the past, I explore the social sense in which individuals can dwell in the past due to oppressive social structures by examining the case of racialized oppression. The case of racialization is philosophically stimulating because of its intersubjective dimensions—it subverts the idea that dwelling in the past is simply a psychological phenomenon by capturing that others can help or hinder us with maintaining a sense of self and future-directed intentionality. By putting the phenomenological work of Al-Saji into conversation with recent phenomenological research on incarceration, I propose that racialization can be similarly disruptive to one’s sense of self and intersubjectivity. The proposed account is suggestive that traumatic and oppressive experiences may amplify and compound each other in ways not yet well elucidated in the literature. If this account is taken to be persuasive, it is indicative that both psychological and social conditions mediate one’s temporality and well-being. (shrink)