During recovery from psychosis (diagnosed as schizophrenia) things must often be done slower than normally expected. The tempo of the socially shared reality is often experienced as being too fast for the recovering person. We will describe how this impairment stems from the pre-reflective mental structure underlying psychosis and how it can be transferred into an active skill supporting recovery, often including social retreat. In this paper, co-written by a psychiatrist and a person experienced in psychosis (= participatory health research), (...) we will draw on personal experiences, (participatory) qualitative research and first-hand accounts for our arguments. We will sketch out the process and three crucial building blocks of recovery: laid-back situations, switch-off skills, places to talk. We will then describe the acquired skill of slowing-down as an amalgam of the building blocks ‘switch-off skill’ and ‘laid-back situation’, since slowing-down answers the situation in a laid-back manner and enforces a slow behavioral pace on it. While this might be okay in private and in some situations shared with others (i.e. during serene situations), it may be tantalizing for others in many everyday situations resulting in stigma or exclusion (i.e. during work). Slowing-down therefore challenges the surrounding others and demonstrates the necessity to synchronize private and public tempos. This is most challenging while living in two realities at once, being the second and often a long-lasting stage of recovery (stage of double realities). (shrink)

_Phenomenological insights into health issues relating to bodily self-experience, normality and deviance, self-alienation, and objectification._.

Stephens and Graham maintain that in cases of thought insertion, the sense of ownership is preserved, but there is a defect in the sense of agency. However, these theorists overlook the possibility that subjectivity might be preserved despite a defect in the sense of ownership. The claim that schizophrenia centers upon a loss of a sense of ownership is supported by an examination of some of the other notable disownership symptoms of the disorder, such as bodily alienation and experiences of (...) “unworlding.” Is there a way to make sense of the “underlying characteristic modification” that ties together the various symptoms of schizophrenia and disrupts subjects’ “hold” on their own bodies and surroundings? I will argue that what accounts for subjects’ usual sense of ownership are fully embodied processes of causal-contextual information integration, which are made possible by subjects’ affective framing patterns. Attenuated affective framings lead to a loss of a sense of ownership and cause subjects to lose their “grip” on bodily sensations and mental states, which ultimately can result in experiences of thought insertion. I will conclude with some brief remarks about implications for treatment, and point to several body-centered intervention methods that might help to restore subjects’ sense of ownership. (shrink)

This paper argues that intuition plays a role in the diagnosis of schizophrenia and presents its phenomenological rationale. A discussion of self-assessment questionnaires and empirical studies in the clinical setting provides evidence that despite the prevalence of operational diagnosis, the intuitive judgment of schizophrenia continues to take place. Two related notions of intuitive diagnosis are presented: Minkowski’s diagnostic by penetration and Rümke’s praecox feeling. Further on, the paper explores and clarifies the phenomenology behind the praecox feeling. First, it is argued, (...) intuitive diagnosis is neither a feeling nor an experience, but a typification operating at an implicit level. Second, it is not simply subjective as spatially it takes place in the in-between of the clinical interaction. Finally, it is not just momentary, but temporally extended, and, hence, partly reflective. The paper suggests that intuitive diagnosis requires critical testing on the side of the psychiatrist to either confirm or falsify it through reflective operations. In conclusion, the merits and shortcomings of intuitive vs. operational diagnosis are presented. (shrink)

Unmanned Aerial Vehicles, or drones, are increasingly employed for military purposes. They are extolled for improving operational endurance and targeting precision on the one hand and keeping drone crew from harm on the other. In the midst of such praise, what falls by the wayside is an entangled set of concerns about the ways in which the relationship between the pilots and their operational environment is being reconfigured. This paper traces the various manifestations of this reconfiguration and goes on to (...) situate our being-with drones in a broader set of sociotechnical practices that shape our understanding of visual technologies. Our inquiry is grounded in technical reports of performance, media coverage of accidents, as well as a detailed first-person account of a former drone pilot. Our analysis suggests that being-with drones is disciplining our perception in subtle ways that remain underexplored. We conclude that when it comes to appraising technologies that interface with the human sensorium, functionalist claims of enhancement are inadequate to the task and propose that phenomenology’s commitment to the phenomena themselves can serve as a useful corrective. (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)

In this paper the question of autonomy in delusional disorders is investigated using a phenomenological approach. I refer to the distinction between freedom of intentional action, and freedom of the will, and develop phenomenological descriptions of lived autonomy, taking into account the distinction between a pre-reflective and a reflective type. Drawing on a case report, I deliver finely-grained phenomenological descriptions of lived autonomy and experienced self-determination when acting on delusions. This analysis seeks to demonstrate that a person with delusions can (...) be described as responsible for her behaviour on a ‘framed’ level (level of freedom of intentional action), even though she is not autonomous on a higher (‘framing’) level (level of freedom of the will), if, and only if, the goods of agency for herself and others are respected. In these cases the person with delusions is very nearly comparable to people in love, who are also not free to choose their convictions, and who could also be rightly held responsible for the behaviour flowing from their convictions. (shrink)