The "minimal self" in psychopathology: re-examining the self-disorders in the schizophrenia spectrum

The notion of minimal, basic, pre-reflective or core self is currently debated in the philosophy of mind, cognitive sciences and developmental psychology. However, it is not clear which experiential features such a self is believed to possess. Studying the schizophrenic experience may help exploring the following aspects of the minimal self: the notion of perspective and first person perspective, the 'mineness' of the phenomenal field, the questions of transparency, embodiment of point of view, and the issues of agency and ownership, considered as different and less fundamental than the feeling of mineness. Two clinical vignettes of patients with the diagnosis of schizophrenia will be presented: the first one, illustrating early illness stages, and the second case, of chronic schizophrenia, symptomatically marked by persistent hallucinations. Through their analysis, we will discuss the experiential dimensions of minimal self.     

What can self-disorders in schizophrenia tell us about the nature of subjectivity? A psychopathological investigation

The purpose of this article is to show how schizophrenia, understood as a distortion of the most intimate structures of subjectivity, illustrates the nature of subjectivity as such, while at the same time how philosophical considerations may help to understand schizophrenia. More precisely, schizophrenic experiences of self-alienation seem to reflect a congealing or concretization of a form of differentiation or potential alterity implicit in the dynamic nature of subjectivity. In other words, we propose that the structure of subjectivity includes potential divisions and fissures that condition the experiences of radical self-alienation seen in schizophrenia. In order to elucidate how this alterity emerges within the self in schizophrenia and in order to consider its conditions of possibility we examine the disorders of the self as described in phenomenological psychopathology. We especially use the work of the Japanese psychiatrists Mari Nagai, her teacher Bin Kimura, and the French psychiatrist Henry Ey, supplemented with clinical material from our own research. Finally, we shed light on the development of the psychotic symptoms such as hallucinations and delusions, which are understood as the expressions of a radical alterization (i.e., becoming other) of the self.     

Pre-reflective self-as-subject from experiential and empirical perspectives

In the first part of this paper I characterize a minimal form of self-consciousness, namely pre-reflective self-consciousness. It is a constant structural feature of conscious experience, and corresponds to the consciousness of the self-as-subject that is not taken as an intentional object. In the second part, I argue that contemporary cognitive neuroscience has by and large missed this fundamental form of self-consciousness in its investigation of various forms of self-experience. In the third part, I exemplify how the notion of pre-reflective self-awareness can be of relevance for empirical research. In particular, I propose to interpret processes of sensorimotor integration in light of the phenomenological approach that allows the definition of pre-reflective self-consciousness.     

All in My Head: Beckett,Schizophrenia and the Self

This article will explore the representation of certain mental and somatic phenomena in Beckett’s trilogy of novels Molloy, Malone Dies and The Unnamable, exploring how his understanding of schizophrenia and psychosis informs his representation of the relationship between mind and body. It will also examine recent phenomenological and philosophical accounts of schizophrenia (Louis Sass, Josef Parnas, Shaun Gallagher) that see the condition as a disorder of selfhood and concentrate in it on the disruption to ipseity, a fundamental and pre-reflective awareness of self that leads to a loss of ‘grip’ (in the term of Merleau-Ponty) on concepts and percepts. Beckett’s writing might, it is argued, make such disruptions more tangible and intelligible. The article will also consider John Campbell’s argument that immunity of the first person to error—Sydney Shoemaker’s foundational philosophical idea that we cannot misspeak the first person pronoun—is revoked in states of psychosis, and relate such states to the moments in Beckett’s writing where this immunity is challenged, and quasi-psychotic experiences represented.     

Cognition in schizophrenia: does working memory work?

Recent research suggests that disturbances in social and occupational functioning in individuals with schizophrenia may be more influenced by the severity of cognitive deficits than by the severity of symptoms such as hallucinations and delusions. In this article, I review evidence that one component of cognitive dysfunction in schizophrenia is a deficit in working memory, associated with disturbances in the dopamine system in dorsolateral prefrontal cortex. I suggest that although the cognitive deficits in schizophrenia include working memory dysfunction, because they arise from a disturbance in executive control processes (e.g., the representation and maintenance of context), they extend to a range of cognitive domains. Finally, I discuss the need for further research on the ways in which contextual processing deficits may influence other aspects of this illness, including emotional processing.     

“Seeing Rain”: Integrating phenomenological and Bayesian predictive coding approaches to visual hallucinations and self-disturbances (Ichstörungen) in schizophrenia

We present a schizophrenia patient who reports “seeing rain” with attendant somatosensory features which separate him from his surroundings. Because visual/multimodal hallucinations are understudied in schizophrenia, we examine a case history to determine the role of these hallucinations in self-disturbances (Ichstörungen). Developed by the early Heidelberg School, self-disturbances comprise two components: 1. The self experiences its own automatic processing as alien to self in a split-off, “doubled-I.” 2. In “I-paralysis,” the disruption to automatic processing is now outside the self in omnipotent agents. Self-disturbances (as indicated by visual/multimodal hallucinations) involve impairment in the ability to predict moment-to-moment experiences in the ongoing perception-action cycle. The phenomenological approach to subjective experience of self-disturbances complements efforts to model psychosis using the computational framework of hierarchical predictive coding. We conclude that self-disturbances play an adaptive, compensatory role following the uncoupling of perception and action, and possibly, other low-level perceptual anomalies.     

The Pre-reflective Situational Self

It is often held that to have a conscious experience presupposes having some form of implicit self-awareness. The most dominant phenomenological view usually claims that we essentially perceive experiences as our own. This is the so called “mineness” character, or dimension of experience. According to  this view, mineness is not only essential to conscious experience, it also grounds the idea that pre-reflective self-awareness constitutes a minimal self. In this paper, we show that there are reasons to doubt this constituting role of mineness. We argue that there are alternative possibilities and that the necessity for an adequate theory of the self within psychopathology gives us good reasons to believe that we need a thicker notion of the pre-reflective self. To this end, we develop such a notion: the Pre-Reflective Situational Self. To do so, we will first show how alternative conceptions of pre-reflective self-awareness point to philosophical problems with the standard phenomenological view. We claim that this is mainly due to fact that within the phenomenological account the mineness aspect is implicitly playing several roles. Consequently, we argue that a thin interpretation of pre-reflective self-awareness—based on a thin notion of mineness—cannot do its needed job within, at least within psychopathology. This leads us to believe that a thicker conception of pre-reflective self is needed. We, therefore, develop the notion of the pre-reflective situational self by analyzing the dynamical nature of the relation between self-awareness and the world, specifically through our interactive inhabitation of the social world.

     

The unity of hallucinations

My primary aim in this article is to provide a philosophical account of the unity of hallucinations, which can capture both perceptual hallucinations (which are subjectively indistinguishable from perceptions) and non-perceptual hallucinations (all others). Besides, I also mean to clarify further the division of labour and the nature of the collaboration between philosophy and the cognitive sciences. Assuming that the epistemic conception of hallucinations put forward by M. G. F. Martin and others is largely on the right track, I will focus on two main tasks: (a) to provide a satisfactory phenomenology of the subjective character of perceptions and perceptual hallucinations and (b) to redress the philosophers’ neglect of non-perceptual hallucinations. More specifically, I intend to apply one of the central tenets of the epistemic conception—that hallucinations can and should be positively characterised in terms of their phenomenological connections to perceptions—to non-perceptual hallucinations as well. That is, I will try to show that we can positively specify the class of non-perceptual hallucinations by reference to the distinctive ways in which we first-personally experience them and perceptions in consciousness. The task of saying more about their underlying third-personal nature may then be left to the cognitive sciences.     

Context binding and hallucination predisposition

Patients with schizophrenia and current auditory hallucinations exhibit a combination of deficits in context binding and intentional inhibition. Hallucinations also occur in the general population suggesting an underlying continuity of causal mechanisms, however, these experiences may also differ (e.g., in frequency), indicating some differences in aetiology. The aim of this study was to examine the frequency of hallucinatory experiences in healthy young adults and to assess whether difficulties in context binding characterize individuals highly predisposed to hallucinations. A modified version of the Launay–Slade hallucination scale-revised, including an assessment of the frequency of hallucination experiences, was completed by 615 undergraduates from which sub-samples of high (n = 25) and low (n = 27) scorers were drawn. Context memory ability was assessed using a voice–location binding task. The results showed that the frequency of hallucinations in high LSHS-R scorers was much less than that previously reported for individuals with schizophrenia. Furthermore, no group differences in context memory binding were observed, nor any association between hallucination frequency and context binding difficulties. The continuity model of hallucinations may overlook some important differences in hallucinatory experiences in the general population versus psychosis.     

The pre-reflective experience of “I” as a continuously existing being: The role of temporal functional binding

The present moment is of infinitesimally brief duration. In the brain, however, there are perceptual processes that bind together events occurring at different times, on a time scale of milliseconds, into a coherent and integrated temporal representation. These processes include temporal integration, as in perception of biological motion, synchronisation, and change detection. These processes are also responsible for temporal integration and coherence in inner mental life, such as in mental imagery. I argue that this gives rise to the pre-reflective experience of the self as a continuously existing being. Temporal integration is also a feature of the experience of action–outcome relations, and I argue that this produces a pre-reflective experience of the self, not just as continuously existing, but also as the doer of both physical and mental actions. This is the foundation on which the idea of the self as continuously existing on longer time scales – the narrative self – is built.     

Modes of Self-Awareness: Perception,Dreams, Memory

Husserl Studies - I contend that the well-established phenomenological distinction between reflective and pre-reflective self-awareness needs to be further supplemented with more refined...     

Narcolepsy: differential diagnosis or etiology in some cases of bipolar disorder and schizophrenia?

Does narcolepsy, a neurological disease, need to be considered when diagnosing major mental illness? Clinicians have reported cases of narcolepsy with prominent hypnagogic hallucinations that were mistakenly diagnosed as schizophrenia. In some bipolar disorder patients with narcolepsy, the HH resulted in their receiving a more severe diagnosis (ie, bipolar disorder with psychotic features or schizoaffective disorder). The role of narcolepsy in psychiatric patients has remained obscure and problematic, and it may be more prevalent than commonly believed. Classical narcolepsy patients display the clinical "tetrad"--cataplexy, hypnagogic hallucinations, daytime sleep attacks, and sleep paralysis. Over 85% also display the human leukocyte antigen marker DQB1*0602 (subset of DQ6). Since 1998, discoveries in neuroanatomy and neurophysiology have greatly advanced the understanding of narcolepsy, which involves a nearly total loss of the recently discovered orexin/hypocretin (hypocretin) neurons of the hypothalamus, likely by an autoimmune mechanism. Hypocretin neurons normally supply excitatory signals to brainstem nuclei producing norepinephrine, serotonin, histamine, and dopamine, with resultant suppression of sleep. They also project to basal forebrain areas and cortex. A literature review regarding the differential diagnosis of narcolepsy, affective disorder, and schizophrenia is presented. Furthermore, it is now possible to rule out classical narcolepsy in difficult psychiatric cases. Surprisingly, psychotic patients with narcolepsy will likely require stimulants to fully recover. Many conventional antipsychotic drugs would worsen their symptoms and make them appear to become a "chronic psychotic," while in fact they can now be properly diagnosed and treated.     

Enculturation and narrative practices

Recent work on enculturation suggests that our cognitive capacities are significantly transformed in the course of the scaffolded acquisition of cognitive practices such as reading and writing. Phylogenetically, enculturation is the result of the co-evolution of human organisms and their socio-culturally structured cognitive niche. It is rendered possible by evolved cerebral and extra-cerebral bodily learning mechanisms that make human organisms apt to acquire culturally inherited cognitive practices. In addition, cultural learning allows for the intergenerational transmission of relevant knowledge and skills. Ontogenetically, enculturation is associated with neural plasticity and the development of new motor routines and action schemas. It relies on scaffolded learning that structures novice-teacher interactions. The acquisition of reading and writing are paradigm examples of enculturation. Based on an empirically informed analysis of the components of enculturation, I will apply the emerging account of enculturated cognition to narrative practices. To date, research on the impact of narratives on the constitution of the self and our understanding of folk psychology has not paid much attention to the question how narratives are influenced by cumulative cultural evolution and our capacity to acquire reading and writing during ontogeny. I will argue that textual narratives, above and beyond oral narratives, provide genuinely new ways of narration. Therefore, the enculturated interaction with textual narratives has the potential to contribute to a better understanding of ourselves and other cognitive agents.     

The Application of Cognitive Therapy for Command Hallucinations

It has become increasingly recognized that cognitive therapy (CT) is an effective treatment for the positive symptoms of schizophrenia yet there are few cognitive therapists in North America who are specialized to work with this patient population. There is a need for further dissemination of CT for schizophrenia in order to increase its availability. A first step in dissemination is to become familiar with the cognitive theory and therapy model, as applied to schizophrenia. The purpose of the present paper is to demonstrate the applicability of CT for psychosis, using the example of command hallucinations. First, we summarize the cognitive theory of command hallucinations and present the stages of CT, using the example of “Joe,” a 24-year-old male with schizophrenia. The paper concludes with practical suggestions of how to enhance the effectiveness of CT for command hallucinations.     

Auditory Verbal Hallucinations as Dialogical Experiences

The purpose of this study is to offer a model in which auditory verbal hallucinations (AVHs) can be conceptualized as dialogical experiences. This model is of interest in that it integrates several different perspectives (phenomenological, cognitive, social, and evolutionary) and the findings of empirical research on the subject. Hallucinations are understood as the product of a state of consciousness in which the self is dissociated into different positions or perspectives. After reviewing the most relevant results of psychological research, dialogical self theory is proposed as the theoretical framework for understanding hallucinatory experiences. It is argued that the voices possess a series of characteristics, pragmatic properties, relationships with the voices similar to their social surroundings, and more dissociative experiences in people who experience voices than in those who do not, with which they may be considered a dialogical experience. Finally, a model attempting to integrate psychological research on AVHs within the framework of dialogical self theory is presented.     

Convergence of biological and psychological perspectives on cognitive coordination in schizophrenia

The concept of locally specialized functions dominates research on higher brain function and its disorders. Locally specialized functions must be complemented by processes that coordinate those functions, however, and impairment of coordinating processes may be central to some psychotic conditions. Evidence for processes that coordinate activity is provided by neurobiological and psychological studies of contextual disambiguation and dynamic grouping. Mechanisms by which this important class of cognitive functions could be achieved include those long-range connections within and between cortical regions that activate synaptic channels via NMDA-receptors, and which control gain through their voltage-dependent mode of operation. An impairment of these mechanisms is central to PCP-psychosis, and the cognitive capabilities that they could provide are impaired in some forms of schizophrenia. We conclude that impaired cognitive coordination due to reduced ion flow through NMDA-channels is involved in schizophrenia, and we suggest that it may also be involved in other disorders. This perspective suggests several ways in which further research could enhance our understanding of cognitive coordination, its neural basis, and its relevance to psychopathology.     

Displaced Feeling: A (Partial) Phenomenological Study

This is a partial phenomenological study of a phenomenon that I call “displaced feeling”, which is best illustrated through a concrete example. I am overcome by a strong desire to stop writing. For one reason or another, I reject the possibility of pursuing this desire. Instead of giving up the desire altogether, however, I may “speak to myself” as follows: “I feel like having a coffee” and, the chatter goes on in the background “of course to make coffee means to stop writing”. I endorse the desire to get a cup of coffee. But the action through which I pursue this desire is coloured not by the feeling that anticipates the value associated with drinking coffee but by a feeling that anticipates the value associated with stopping writing. The latter feeling has displaced the former: I am in a state of displaced feeling. Here, I will elucidate two invariant structures of displaced feeling. First, I will show that displaced feeling involves the realisation of an endorsed state of affairs, the bringing about of a rejected state of affairs, and the belief that the former will determine the latter. Next, I will show that the endorsed state of affairs appears prominently as the end of an intention (or projection), that the rejected state of affairs appears inconspicuously in the horizon of the same intention, and that the belief appears twice: (1) as a motive for this intention and (2) as the “glue” that keeps its prominent and inconspicuous zones together.     

Applying cognitive training to target executive functions during early development

Developmental psychopathology is increasingly recognizing the importance of distinguishing causal processes (i.e., the mechanisms that cause a disease) from developmental outcomes (i.e., the symptoms of the disorder as it is eventually diagnosed). Targeting causal processes early in disordered development may be more effective than waiting until outcomes are established and then trying to reverse the pathogenic process. In this review, I evaluate evidence suggesting that neural and behavioral plasticity may be greatest at very early stages of development. I also describe correlational evidence suggesting that, across a number of conditions, early emerging individual differences in attentional control and working memory may play a role in mediating later-developing differences in academic and other forms of learning. I review the currently small number of studies that applied direct and indirect cognitive training targeted at young individuals and discuss methodological challenges associated with targeting this age group. I also discuss a number of ways in which early, targeted cognitive training may be used to help us understand the developmental mechanisms subserving typical and atypical cognitive development.     

自然自明性的失落——Blankenburg精神分裂理论述评

传统的精神分裂研究,关注的主要是精神分裂的妄想症候群。因为精神分裂中相对特殊的症状,在妄想形式中可以得到最轻易的把握。Blankenburg则认为:精神分裂的本质结构变异是先于妄想的。因此,他致力于在精神分裂的症状贫乏型(主要是青春型和单纯型)中,寻找精神分裂的本质变异。他发现:精神分裂异常中的核心缺损是自然自明性的失落。根据胡塞尔的超越现象学,自然自明性失落有四个原因:与世界关系的改变、时间建构的改变、自我建构的改变、交互主体性的改变。Blankenburg的精神分裂理论,作为二十世纪有关精神分裂的最重要工作之一,对于今天的精神分裂研究仍然有极其重要的意义。     

The illusion of reality: a review and integration of psychological research on hallucinations

Hallucinations are among the most severe and puzzling forms of psychopathology. Although usually regarded as first-rank symptoms of schizophrenia, they are found in a wide range of medical and psychiatric conditions. Moreover, a substantial minority of otherwise normal individuals report hallucinatory experiences. The purpose of this article is to review the considerable research into the cognitive mechanisms underlying (particularly psychotic) hallucinations that has been carried out and to integrate this research within a general framework. The available evidence suggests that hallucinations result from a failure of the metacognitive skills involved in discriminating between self-generated and external sources of information. It is likely that different aspects of these skills are implicated in different types of hallucinatory experiences. Further research should focus on specific metacognitive deficits associated with different types of hallucinations and on treatment strategies designed to train hallucinators to reattribute thoughts to themselves.