In 1910, Karl Jaspers wrote a seminal essay on morbid jealousy in which he laid the foundation for the psychopathological phenomenology that through his work and the work of Hans Gruhle and Kurt Schneider, among others, would become the ...

Phenomenological psychiatry has suffered from a failure to translate its insights into terms specific enough to be applied to psychiatric diagnosis or to be used in contemporary research programs. This difficulty can be understood in light of the well-known tradeoff between reliability and validity. We argue, however, that with sufficient ingenuity, phenomenological concepts can be adapted and applied in a research context. Elsewhere, we have described a phenomenologically oriented conception of schizophrenia as a self- or ipseity-disorder with two main facets: (...) decline in the sense of existing as a subject of awareness (diminished self-affection) and heightened awareness of aspects of experience that would normally remain tacit or presupposed (hyperreflexivity). This approach is consistent with Minkowski, Blankenburg, and Kimura and offers one possible synthesis of their views. Here we describe two areas of empirical research that are congruent with, or actually inspired by, a phenomenological approach emphasizing such disorders of consciousness and self-experience: (1) Phenomenologically oriented, interview studies show that, whereas negative-symptom patients generally deny any diminishment of affect and thinking, they do describe qualitative alterations of experience suggestive of hyperreflexivity and diminished self-affection. (2) Another line of research suggests that the early detection of schizophrenic symptoms may be enhanced by adopting a phenomenological approach. (shrink)

In recent years, there has been much focus on the apparent heterogeneity of schizophrenic symptoms. By contrast, this article proposes a unifying account emphasizing basic abnormalities of consciousness that underlie and also antecede a disparate assortment of signs and symptoms. Schizophrenia, we argue, is fundamentally a self-disorder or ipseity disturbance that is characterized by complementary distortions of the act of awareness: hyperreflexivity and diminished self-affection. Hyperreflexivity refers to forms of exaggerated self-consciousness in which aspects of oneself are experienced as akin (...) to external objects. Diminished self-affection or self-presence refers to a weakened sense of existing as a vital and self-coinciding source of awareness and action. This article integrates recent psychiatric research and European phenomenological psychiatry with some current work in cognitive science and phenomenological philosophy. After introducing the phenomenological approach along with a theoretical account of normal consciousness and self-awareness, we turn to a variety of schizophrenic syndromes. We examine positive, then negative, and finally disorganization symptoms—attempting in each case to illuminate shared distortions of consciousness and the sense of self. We conclude by discussing the possible relevance of this approach for identifying early schizophrenic symptoms. (shrink)

Delusions are usually defined as false beliefs about the state of affairs in the public world. Taking this premise as unquestionable, the debate in cognitive science tends to oscillate between the so-called 'rationalist approach'- proposing some breakdown in the central intellective modules embodying human rationality - and the 'empiricist approach' - proposing a primary peripheral deficit , followed by explanatory efforts in the form of delusions. In this article the foundational assumption about delusion is questioned. Especially in the case of (...) schizophrenia, delusions are not epistemic statements about external world but metaphorical reports of altered structure of experiencing . Delusions as epistemic statements or beliefs occur paradigmatically in delusional disorder . These two types of delusions are compared from a primarily phenomenological stance. (shrink)

How can we better understand and treat those suffering from schizophrenia and manic-depressive illnesses? This important new book takes us into the world of those suffering from such disorders. Using self descriptions, its emphasis is not on how mental health professionals view sufferers, but on how the patients themselves experience their disorder. A new volume in the International Perspectives in Philosophy and Psychiatry series, this book will be of great interest to all those working with sufferers from such disorders - (...) helping them to better understand their mental lives, and providing important insights into how best to treat them. (shrink)

Objective: The clinical hallmark of schizophrenia is psychosis. The objective of this overview is to link the neurobiology (brain), the phenomenological experience (mind), and pharmacological aspects of psychosis-in-schizophrenia into a unitary framework. -/- Method: Current ideas regarding the neurobiology and phenomenology of psychosis and schizophrenia, the role of dopamine, and the mechanism of action of antipsychotic medication were integrated to develop this framework. -/- Results: A central role of dopamine is to mediate the "salience" of environmental events and internal representations. (...) It is proposed that a dysregulated, hyperdopaminergic state, at a "brain" level of description and analysis, leads to an aberrant assignment of salience to the elements of one's experience, at a "mind" level. Delusions are a cognitive effort by the patient to make sense of these aberrantly salient experiences, whereas hallucinations reflect a direct experience of the aberrant salience of internal representations. Antipsychotics "dampen the salience" of these abnormal experiences and by doing so permit the resolution of symptoms. The antipsychotics do not erase the symptoms but provide the platform for a process of psychological resolution. However, if antipsychotic treatment is stopped, the dysregulated neurochemistry returns, the dormant ideas and experiences become reinvested with aberrant salience, and a relapse occurs. -/- Conclusions: The article provides a heuristic framework for linking the psychological and biological in psychosis. Predictions of this hypothesis, particularly regarding the possibility of synergy between psychological and pharmacological therapies, are presented. The author describes how the hypothesis is complementary to other ideas about psychosis and also discusses its limitations. (shrink)

This article presents an introductory overview of the interpretations of schizophrenia offered by three phenomenological psychiatrists: Eugene Minkowski (1885-1972), Wolfgang Blankenburg (b. 1928), and Kimura Bin (b. 1931). Minkowski views schizophrenia as characterized by a diminished sense of dynamic and vital connection to the world ("loss of vital contact"), often accompanied by a hypertrophy of intellectual and static tendencies ("morbid rationalism," "morbid geometrism"). Blankenburg emphasizes the patient's loss of the normal sense of obviousness or "natural self-evidence"—a loss of the usual (...) common-sense background that enables normal persons to cope easily with the social and practical world. Kimura focuses on certain distortions of self-experience: a distinctive splitting of the subjective self, alienated awareness of one's own ongoing consciousness, and profound uncertainty about the "I-ness" of the self. In addition to a summary, this article offers a comparison and critique of these three approaches. The three approaches are also considered in light of a more recent, phenomenological formulation of schizophrenia as a disorder of self-experience (an ipseity disturbance) involving hyperreflexivity and diminished self-affection (i.e., heightened awareness of aspects of experience that would normally remain tacit or presupposed and decline in the feeling of existing as a subject of awareness). (shrink)