Schizophrenia

Die Wiederaufnahme unterbrochener Handlungen nach der Aussetzung der Maßnahmen zur Eindämmung von CoVid19 veranschaulicht Unveränderlichkeit und Unvergänglichkeit regressives Zustandes, in dem sich weite Teile der Bevölkerung befinden. Nach kurzer Unterbrechung kommt alles in gewöhnten Kreis alltäglicher Routine und Gedankenlosigkeit, mit denen solche Aufgaben erledigt werden. Nichts, aber gar nichts änderte sich nach dem Unglück, das eigentlich, wie in meisten solchen Fällen, die Gelegenheit bietet, über sich selbst und die Welt nachzudenken.

I argue that ordinary confabulation is a side-effect of an interpretive faculty that makes sense of the world by rationalising our experience within the context of a personal and cultural narrative. However, I argue that a hyperactivity of the same process manifests as schizotypy—latent schizophrenic tendencies—that can lead to extreme dissociation of interpretation from experience. I first give a phenomenological account of the process of interpretation, arguing that it is enacted through the creation of conceptual cognitive content from an originary (...) non-conceptual experience. I then ground this account in empirical evidence, showing how our direct perception is moulded and adapted as it is conceptualised to fit our individual and collective expectations. Finally, I argue that hyperactive over-interpretation results in schizotypic dissociation, thus suggesting that schizophrenia should be understood as a disorder of interpretation, the extreme end of a spectrum that includes ordinary confabulation. (shrink)

Schizophrenia in adolescents and the family system Empirical research shows that chronic diseases have specific, idiosyncratic functions in the family, and give real, psychosocial advantages. This leaves the question - can schizophrenic disorders have similar function in the family system as a chronic somatic disease? We have analyzed systemic family traits in families with schizophrenic young patients. The reference samples were two kinds of families: families with schizophrenic adults and families without any chronic disease or chronic illness. The subjects of (...) analysis were coefficients of the systemic features, identified by factor analysis according to author's proposal. Oneway Anova was used to compare indexes between three groups of families. The results show that mental disorder in adolescents participates in the life of the whole family, having similar functions to the functions of chronic somatic diseases. They also suggest that, from the family members' point of view, schizophrenic disorders in a teenagers has different quality compared to schizophrenic disorders in an adult. (shrink)

Schizophrenia has historically been considered a severe psychiatric disorder with a chronic and progressive course; an assumption that has shaped both clinical research and public policy. Recent studies have suggested, however, that many people recover from this disorder to varying degrees, prompting new research approaches that focus on factors influencing improvement as well as pathology. An empirical-phenomenological approach appears especially promising as an avenue to investigating the active role the person may play in improvement. The dimensions of everyday life that (...) are discussed as providing a conceptual framework for investigations of the active role of the person are intentionality, temporality, and meaning. Within this framework a four-step process of recovering and reconstructing the self in schizophrenia is then delineated, with concrete illustrations of each step drawn from interviews with one young woman with schizophrenia. The findings are taken to represent the kinds of valuable insights that may be garnered from an empirical-phenomenological approach to research built upon a recognition of the importance of the dimensions of intentionality, temporality, and meaning in the everyday life of those afflicied with severe mental illness. There is only the fight to recover what has been lost And found and lost again and again. T. S. Eliot. (shrink)

In this article, I compare and evaluate R. D. Laing and A. Esterson’s account of schizophrenia as developed in Sanity, Madness and the Family, social models of disability, and accounts of extended mental disorder. These accounts claim that some putative disorders should not be thought of as reflecting biological or psychological dysfunction within the afflicted individual, but instead as external problems. In this article, I consider the grounds on which such claims might be supported. I argue that problems should not (...) be located within an individual putative patient in cases where there is some acceptable test environment in which there is no problem. A number of cases where such an argument can show that there is no internal disorder are discussed. I argue, however, that Laing and Esterson’s argument—that schizophrenia is not within diagnosed patients—does not work. The problem with their argument is that they fail to show that the diagnosed women in their study function adequately in any environment. (shrink)

As it emerged from philosophical analyses and cognitive research, most concepts exhibit typicality effects, and resist to the efforts of defining them in terms of necessary and sufficient conditions. This holds also in the case of many medical concepts. This is a problem for the design of computer science ontologies, since knowledge representation formalisms commonly adopted in this field (such as, in the first place, the Web Ontology Language - OWL) do not allow for the representation of concepts in terms (...) of typical traits. The need of representing concepts in terms of typical traits concerns almost every domain of real world knowledge, including medical domains. In particular, in this article we take into account the domain of mental disorders, starting from the DSM-5 descriptions of some specific disorders. We favour a hybrid approach to concept representation, in which ontology oriented formalisms are combined to a geometric representation of knowledge based on conceptual space. As a preliminary step to apply our proposal to mental disorder concepts, we started to develop an OWL ontology of the schizophrenia spectrum, which is as close as possible to the DSM-5 descriptions. (shrink)

Scientists, philosophers, and even the lay public commonly accept that schizophrenia stems from a biological or internal ‘dysfunction.’ However, this assessment is typically accompanied neither by well-defined criteria for determining that something is dysfunctional nor empirical evidence that schizophrenia satisfies those criteria. In the following, a concept of biological function is developed and applied to a neurobiological model of schizophrenia. It concludes that current evidence does not warrant the claim that schizophrenia stems from a biological dysfunction, and, in fact, that (...) unusual neural structures associated with schizophrenia may have functional or adaptive significance. The fact that current evidence is ambivalent between these two possibilities (dysfunction versus adaptive function) implies that schizophrenia researchers should be much more cautious in using the ‘dysfunction’ label than they currently are. This has implications for both psychiatric treatment as well as public perception of mental disorders. (shrink)

Diagnostic terms in psychiatry like ‘schizophrenia’ and ‘bipolar disorder’ are deeply contested in the professional community, by mental health activists and the public. In this paper, we provide a theoretical framework for considering diagnostic terms as ordinary linguistic expressions and illustrate this approach by a corpus linguistic analysis of ‘schizophrenia.’ Our aim is to show how a focus on language itself can inform current and future debates about psychiatric terminology and provide new insights on relevant processes concerning their actual usage (...) and change over time. We hope that this contributes to enhancing mutual understanding between different discourse spheres and stakeholders. (shrink)

Today the concept of 'schizophrenia' is often presented in psychiatric texts as a construct, a construct bringing together a diverse and, allegedly, independently assailable range of signs and symptoms. According to such a diagnostic scheme two patients may both be allowed to count as suffering from schizophrenia despite sharing hardly a single symptom. The validity of the concept has accordingly been contested by psychologists for its apparent lack of unity. In the absence of clear independent evidence of a unitary physiological (...) disease process underlying such diverse phenomena, a natural enough suggestion has been to... (shrink)

In her commentary, Dibitonto helpfully compares my understanding of schizophrenic ego disturbance with that of Blankenburg. His patient Anne described her true schizophrenic difficulty as obtaining in some sense 'before' those experiential disturbances she can articulate. Ordinary conversational modes misleadingly invite her and us to attempt describing her difficulties in terms which presuppose the intactness of, rather than capture the underlying disturbance to, her self-hood. They fail to locate the disturbance deep enough, fail to grasp how it arises 'before' what (...) is readily articulable in the psyche. I believe this is the same 'before' which prompts my own articulation of schizophrenic ego... (shrink)

The mutual interest between embodied cognitive sciences, in particular enactivism, and phenomenological psychopathology has significantly increased in the last 15 years. Gipps's article contributes to this field of research by defining ego boundaries in an enactivist framework to explain how the distinction self-other emerges and is maintained in ordinary healthy conditions, and how it is weakened and impaired in cases of schizophrenia. Gipps's first tenet is: The ego-boundary is enacted equiprimordially with experience, that is, it...

In his commentary, Louis Sass points out some aspects of excentricity that are important to keep in mind when applying the notion to schizophrenia.First, it is true that the failure of the excentric position may not be equated with the naïve egocentricity of Piaget's young child—it is not a "regression" to an earlier developmental stage. On the contrary, paranoid delusion is only possible because the patients had already acquired the excentric position before, for this is what leads them to see (...) themselves "in others' eyes"—namely being observed, spied at, persecuted by them. The problem is rather that their perspective-taking is unbound, forces itself on them, and may not... (shrink)

In "Delusion, Reality, and Intersubjectivity," Thomas Fuchs offers a superb presentation of an enactive/phenomenological approach to schizophrenic delusions—an approach that is clearly superior to the poor-reality-testing formula that has dominated thinking about delusion in psychiatry, psychoanalysis, and cognitive-behavioral theory. As he convincingly argues, two key tendencies go a long way toward accounting for the distinctive features of delusion in schizophrenia: 1) withdrawal from practical, sensori-motoric interaction with the physical environment; and 2) failure to experience reality in intersubjective terms—as a realm (...) of "participatory... (shrink)

Cannabis acutely increases schizotypy and chronic use is associated with elevated rates of psychosis. Creative individuals have higher levels of schizotypy, however links between cannabis use, schizotypy and creativity have not been investigated. We investigated the effects of cannabis smoked naturalistically on schizotypy and divergent thinking, a measure of creativity. One hundred and sixty cannabis users were tested on 1 day when sober and another day when intoxicated with cannabis. State and trait measures of both schizotypy and creativity were administered. (...) Quartile splits compared those lowest and highest in trait creativity. Cannabis increased verbal fluency in low creatives to the same level as that of high creatives. Cannabis increased state psychosis-like symptoms in both groups and the high creativity group were significantly higher in trait schizotypy, but this does not appear to be linked to the verbal fluency change. Acute cannabis use increases divergent thinking as indexed by verbal fluency in low creatives. (shrink)

"Unsere Literatur ist voll von Klagen über den chaotischen Zustand der Systematik der Psychosen, und jeder Psychiater weiß, daß man sich auf Grund der alten Diagnosen gar nicht genügend verständigen kann. (...) So können sich mit den alten Begriffen nicht einmal die Koryphäen der Wissenschaft verständigen, und viele Patienten tragen genau so viele Diagnosen mit sich herum, als sie Anstalten besucht haben. (...) Irrtümer hindern die Wissenschaft am meisten am Fortschreiten; sie zu beseitigen hat mehr praktischen Wert, als eine neue (...) Erkenntnis zu gewinnen. Und hier ist ein ganzes Chaos von Namen beseitigt worden, hinter denen man fälschlicherweise brauchbare Krankheitsbegriffe suchte, und ein Wald von Grenzpfählen, von denen keiner an einer natürlichen Grenze stand. (...) Mit dem Namen der Dementia praecox oder der Schizophrenie bezeichnen wir eine Psychosengruppe, die bald chronisch, bald in Schüben verläuft, in jedem Stadium Halt machen oder zurückgehen kann, aber wohl keine volle Restitutio ad integrum erlaubt. Sie wird charakterisiert durch eine spezifisch geartete, sonst nirgends vorkommende Alteration des Denkens und Fühlens und der Beziehungen zur Außenwelt.". (shrink)

"Our literature is replete with complaints about the chaotic state of the systematics of psychoses and every psychiatrist knows that it is impossible to come to any common understanding on the basis of the old diagnostic labels. ... Thus, not even the masters of science can make themselves understood on the basis of the old concepts and with many patients the number of diagnoses made equals the number of institutions they have been too. ... Errors are the greatest obstacles to (...) the progress of science; to correct such errors is of more practical value than to achieve new knowledge. We have here eliminated chaos of terms behind which useful concepts of disease were mistakenly sought; we have eliminated a veritable forest of boundary posts, not one of which indicated any natural line of demarcation. ... By the term „dementia praecox“ or „schizophrenia“ we designate a group of psychoses whose course is at times chronic, at times marked by intermittent attacks, and which can stop or retrograde at any stage, but does not permit a full restitutio ad integrum. The disease is characterized by a specific type of alteration of thinking, feeling, and relation to the external world which appears nowhere else in this particular fashion." Eugen Bleuler. Dementia Praecox or the Group of Schizophrenias. Translated by Joseph Zinkin. International Universities Press, New York, 1950. (shrink)

This new edition of Mind, Meaning, and Mental Disorder addresses key issues in the philosophy of psychiatry, drawing on both philosophical and scientific theory. The main idea of the book is that causal models of mental disorders have to include meaningful processes as well as any possible lower-level physical causes, and this propsoal is illustrated with detailed discussion of current models of common mental health problems. First published in 1996, this volume played an important role in bridging the gap between (...) philosophy and psychiatry, and introducing those in psychiatry to philosophical ideas somewhat neglected in their field. Completely updated, the new edition of this acclaimed volume draws on the strengths of the first edition, and will be a central text in the burgeoning field of philosophy of psychiatry. (shrink)

This study examined narrative identity in a group of 81 patients with schizophrenia and 50 healthy controls through the recall of self-defining memories. The results indicated that patients’ narratives were less coherent and elaborate than those of controls. Schizophrenia patients were severely impaired in the ability to make connections with the self and extract meaning from their memories, which significantly correlated with illness duration. In agreement with earlier research, patients exhibited an early reminiscence bump. Moreover, the period of the reminiscence (...) bump, which is highly relevant for identity development, was characterized by fewer achievements and more life-threatening event experiences, compared with controls. A negative correlation was found between negative symptoms, number of self-event connections and specificity of narratives. Our results suggest that schizophrenia patients have difficulties to organize and extract meaning from their past experiences in order to create coherent personal narratives. (shrink)

A large body of literature agrees that persons with schizophrenia suffer from a Theory of Mind deficit. However, most empirical studies have focused on third-person, egocentric ToM, underestimating other facets of this complex cognitive skill. Aim of this research is to examine the ToM of schizophrenic persons considering its various aspects, to determine whether some components are more impaired than others.We developed a Theory of Mind Assessment Scale and administered it to 22 persons with a DSM-IV diagnosis of schizophrenia and (...) a matching control group. Th.o.m.a.s. is a semi-structured interview which allows a multi-component measurement of ToM. Both groups were also administered a few existing ToM tasks and the schizophrenic subjects were administered the Positive and Negative Symptoms Scale and the WAIS-R.The schizophrenic persons performed worse than control at all the ToM measurements; however, these deficits appeared to be differently distributed among different components of ToM.Our conclusion is that ToM deficits are not unitary in schizophrenia, which also testifies to the importance of a complete and articulated investigation of ToM. (shrink)

Much of the characteristic symptomatology of schizophrenia can be understood as resulting from a pervasive sense of disembodiment. The body is experienced as an external machine that needs to be controlled with explicit intentional commands, which in turn leads to severe difficulties in interacting with the world in a fluid and intuitive manner. In consequence, there is a characteristic dissociality: Others become problems to be solved by intellectual effort and no longer present opportunities for spontaneous interpersonal alignment. This dissociality goes (...) hand in hand with a progressive loss of the socially extended mind, which normally affords opportunities for co-regulation of cognitive and affective processes. However, at times people with schizophrenia report that they are confronted by the opposite of this dissociality, namely an unusual fluidity of the self-other boundary as expressed in experiences of ambiguous body boundaries, intrusions, and even merging with others. Here the person has not lost access to the socially extended mind but has instead become lost in it, possibly due to a weakened sense of self. We argue that this neglected aspect of schizophrenic social dysfunction can be usefully approached via the concept of genuine intersubjectivity: We normally participate in a shared experience with another person by implicitly co-regulating how our interaction unfolds. This co-regulation integrates our respective experience’s dynamical bases into one interpersonal process and gives the interaction an ambiguous second-person character. The upshot is that reports of abnormal self-other fluidity are not indicative of hallucinations without any basis in reality, but of a heightened sensitivity and vulnerability to processes of interpersonal alignment and mutual incorporation that form the normal basis of social life. We conclude by discussing implications of this view for both the science of consciousness as well as approaches to intervention and therapy. (shrink)

Человек – это память. Чтобы понять, что такое человек, необходимо понять, что такое память.

This chapter discusses the Ganser syndrome and gives a brief account on its clinical features. A significant number of clinicians in Europe continued accepting Ganser's basic postulates that the patients showed significant memory disorder and 'answers towards the question' within the framework of traumatic or reactive hysteria. In elderly patients, Ganser type symptoms may be indicative of the onset of dementia. Ganser syndrome raises the question of the interaction between concepts, ideology and clinical observation. The clinician must be aware that (...) a misdiagnosed case of Ganser-type hysteria may result in lawsuits, unnecessary surgical interventions, inappropriate use of minor and major tranquillizers, and social consequences that may be destabilizing for the patient and family. Positive results in the organic investigation should lead to a firm diagnosis and disconfirmation of Ganser syndrome. Persistent negative results and dramatic improvement should tend to confirm the diagnosis. (shrink)

Deutsche Krankheit: eine Diagnosestellung mit Rückblick und Ausblick auf Krankheitsverlauf.

Functionalist theories of mind sometimes have viewed consciousness as emerging simply from the computational activity of extremely complex information-processing systems. Empirical evidence suggests strongly, however, that experiences without content ("pure consciousness" events, or "core mystical experience") and devoid of subjectivity (no sense of agency or ownership) do happen. The occurrence of such consciousness, lacking all informational content, counts against any theory that equates consciousness with the mere "flow of information," no matter how intricate.

Associationism can be broadly defined as a school of thought in philosophy and psychology that holds that mental activity can be accounted for by processes that combine simple elements or ideas. More than a century ago, scientific psychology started taking measurements of word associations, and only a few years later, word associations became a major research tool in psychiatry. With the advent of neurobiology and the discovery of the neuron, the term association came to denote physical connections between cells or (...) parts of the brain. The resulting ambiguity made the concept highly fruitful and at the same time introduced the risk of committing categorical mistakes and of engaging in unfounded speculation, since little was known about the actual functioning of neurons. In modern cognitive neuroscience, computational models provide the critically needed link between the psychological and the biological approaches. The concept of association, with its biological, psychological, and computational connotations, provides the framework needed for further experimental research. Its potential for contributing to our understanding of psychopathology can hardly be overestimated. (shrink)

Hallucination lies at an intriguing border between psychiatry and philosophy. Although Behrendt & Young (B&Y) tie their proposal to Kantian transcendental idealism, other philosophical positions are equally consistent. Cognition is underconstrained by reality not only in hallucination but also in autism and dreaming. Sensory underconstraint is insufficient to encompass schizophrenia. There is also a breakdown in integrative capacity on the cognitive side. From a wider clinical perspective than schizophrenia, there can be underconstraint or overconstraint in sensory and cognitive functionalities.

John Campbell (1999) has recently maintained that the phenomenon of thought insertion as it is manifested in schizophrenic patients should be described as a case in which the subject is introspectively aware of a certain thought and yet she is wrong in identifying whose thought it is. Hence, according to Campbell, the phenomenon of thought insertion might be taken as a counterexample to the view that introspection-based mental selfascriptions are logically immune to error through misidentification (IEM, hereafter). Thus, if Campbell (...) is right, it would not be true that when the subject makes a mental self-ascription on the basis of introspective awareness of a given mental state, there is no possible world in which she could be wrong as to whether it is really she who has that mental state. Notice the interesting interdisciplinary implications of Campbell’s project: on the one hand, a fairly precise notion elaborated in philosophy such as IEM (and the related notion of error through misidentification, EM hereafter) is used to describe a characteristic symptom of schizophrenia.1 On the other hand, such a phenomenon, described in the way proposed, is taken to be a possible counterexample to a sort of “philosophical dogma” such as IEM of introspection-based non-inferential mental self-ascriptions. In the first section of the paper I will point out the characteristic features of EM and explain logical immunity to error through misidentification of introspection-based mental self-ascriptions; in the second section I will consider the case of thought insertion in more detail and show why, after all, it is not a counterexample to the view that introspectionbased mental self-ascriptions are logically IEM. Finally, I will offer a re-description of the phenomenon of thought insertion. (shrink)

We argue that the pivotal role assigned by Northoff to the principle of top-down modulation in catatonia might successfully be applied to other symptoms of schizophrenia, for example, hallucinations. Second, we propose that Northoff's account would benefit from a more comprehensive analysis of the cognitive level of explanation. Finally, contrary to Northoff, we hypothesize that “top-down modulation” might play as important a role as “horizontal modulation” in affective-behavioral alterations.

The key mutation of the schizophrenic psyche can be described as a disturbance of the first person-ness of the I-sense, i.e., of the sense of the "I" as personal subject of experience and of action. Under these circumstances, representations of things are not definitively experienced as "my" representations—with the self-evidence of belonging to me. This uncertainty of selfhood, specific to schizophrenia, cannot be reduced to a disability of intellect, logic, judgment, or memory. In the course of developing his argument, the (...) author criticizes philosopher Michel Henry's critique of Heidegger's (1961) interpretation of Descartes's cogito ergo sum. (shrink)

Extant philosophical accounts of schizophrenic alien thought neglect three clinically signifi cant features of the phenomenon. First, not only thoughts, but also impulses and feelings, are experienced as alien. Second, only a select array of thoughts, impulses, and feelings are experienced as alien. Th ird, empathy with experiences of alienation is possible. I provide an account of disownership that does justice to these features by drawing on recent work on delusions and selfknowledge. Th e key idea is that disownership occurs (...) when there is a failure of rational control over one’s mind. Th is produces a clash between the deliverances of introspection and practical enquiry as ways of knowing one’s mind. Th is explanation places disownership on a continuum with more common aspects of our psychological life, such as addiction, akrasia, obsessional thinking, and immoral, selfi sh or shameful thoughts. I conclude by addressing objections, and exploring the relevance of my account to questions in the philosophy of psychiatry concerning the validity of our current taxonomy of symptoms, and the nature of psychiatric classifi cation.. (shrink)

Classifying Madness (Springer, 2005) concerns philosophical problems with the Diagnostic and Statistical Manual of Mental Disorders, more commonly known as the D.S.M. The D.S.M. is published by the American Psychiatric Association and aims to list and describe all mental disorders. The first half of Classifying Madness asks whether the project of constructing a classification of mental disorders that reflects natural distinctions makes sense. Chapters examine the nature of mental illness, and also consider whether mental disorders fall into natural kinds. The (...) second half of the book addresses epistemic worries. Even supposing a natural classification system to be possible in principle, there may be reasons to be suspicious of the categories included in the D.S.M. I examine the extent to which the D.S.M. depends on psychiatric theory, and look at how it has been shaped by social and financial factors. I aim to be critical of the D.S.M. without being antagonistic towards it. Ultimately, however, I am forced to conclude that although the D.S.M. is of immense practical importance, it is unlikely to come to reflect the natural structure of mental disorders. (shrink)