© 2003 by Oxford University Press and the Maryland Psychiatric Research Center (MPRC)
Schizophrenia, Consciousness, and the Self
Professor and Chair, Department of Clinical Psychology, and Research Affiliate, Center for Cognitive Science, Rutgers University Piscataway, NJ
Professor of Psychiatry, Hvidovre Hospital, and Danish National Research Foundation, Center for Subjectivity Research, University of Copenhagen Copenhagen, Denmark
Send reprint requests to Dr. J. Parnas, Department of Psychiatry, Hvidovre Hospital, Brøndbyøstervej 160, DK-2650 Hvidovre, Denmark; e-mail: jpa{at}cfs.ku.dk
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 (ipse is Latin for "self" or "itself") 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.
Keywords: Schizophrenia / self-disorder / consciousness / negative symptoms / positive symptoms / hyperreflexivity
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