Abstract

The present chapter offers a unifying but nonreductive interpretation of schizophrenia, one that attempts to show how the diverse signs and symptoms of this illness may all be rooted in certain fundamental alterations in the acts of consciousness that constitute both self and world. Schizophrenia, I argue, can best be understood as a two-faceted disturbance of self-experience. Phenomena that would normally be inhabited – and in this sense experienced as part of the self – come instead to be taken as objects of focal or objectifying awareness (hyperreflexivity). Intimately connected with this development is a profound weakening of the sense of existing as a subject of awareness, as a presence for oneself and before the world (diminished self-affection). Both facets imply a key disturbance of ipseity, i.e. of the basic sense of existing as a vital and self-coinciding subject of experience or first-person perspective on the world. (Ipse is Latin for self or itself.)

To explain the nature of this self-disturbance, I borrow the philosopher Merleau-Ponty's concept of the intentional arc along with Michael Polanyi's notion of an experiential continuum stretching between the object of awareness and what has a more tacit form of existence. I also distinguish between compensatory, consequential and more basic forms of hyperreflexivity. I consider the positive, negative and disorganized syndromes or types of schizophrenic symptom; and attempt, in each case, to illuminate the role of shared disturbances of consciousness and the sense of self.

Abstract

In this chapter we attempt to explain one class of symptoms associated with schizophrenia. We concentrate on symptoms that are characterized by a confusion between the self and other, such as auditory hallucinations and delusions of control. We propose that such symptoms arise because of a failure in the mechanism by which the predicted consequences of self-produced actions are derived from an internal forward model. Normally the forward model predicts and cancels the sensory consequences of self-produced actions. We argue that an impairment in this prediction and cancellation mechanism can cause self-produced sensations to be classified as externally produced. This problem leads to a number of behavioural consequences, such as a lack of central error correction, many of which have been observed in patients with delusions of control and related symptoms. At the physiological level, delusions of control are associated with overactivity in the parietal cortex. We suggest that this overactivity results from a failure to attenuate responses to sensations of limb movements even though these sensations can be anticipated on the basis of the movements intended. The lack of attenuation may arise from corticocortical disconnections which prevent inhibitory signals arising in the frontal areas which generate motor commands from reaching the appropriate sensory areas.

Introduction

Auditory hallucinations and passivity symptoms in schizophrenia

Rather than attempting to elucidate a biological basis for schizophrenia, our aim in this chapter is to try and explain one class of symptoms.

Abstract

Introduction

This chapter attempts to integrate a number of experimental findings pertaining to the neural correlates of the self and self-related processing. In this context, we have previously suggested that the brain be viewed as an Alexander Calder mobile, delicate and balanced, with a certain interdependence amongst the elements (Keenan, 2001). Calder's mobiles are fragile, with wire or string holding together elements typically made of metal in such a manner that perfect balance is achieved across the entire creation. These elements, which on some levels can be described as discrete units, are never wholly independent, and their actions shift as the environment changes. Destruction of a single unit often affects the entire brain, even if the change across distant regions is subtle. Further, different environmental conditions, analogous to different cognitive demands, often involve numerous elements, and the same element is often involved under numerous tasks.

Abstract

Initially, three different philosophical concepts of self are distinguished: a Kantian, a hermeneutical, and a phenomenological concept. The phenomenological concept is then analysed in detail. The first step of the analysis consists in an investigation of the first-personal givenness of phenomenal consciousness; the second step involves a discussion of different concepts of self-consciousness, a discussion which culminates in a criticism of the so-called higher-order representation theory. In conclusion, the article provides some examples of how the phenomenological concept of self may be of use in empirical science (psychiatry and developmental psychology).

Introduction

In the following chapter, I wish to outline and discuss some of the reflections on self that can be found in phenomenology. But let me start with a cautionary remark. Phenomenology is not the name of a philosophical position. It is the name of a philosophical tradition inaugurated by Husserl (1859–1938), and comprising among its best-known champions philosophers like Scheler, Heidegger, Schutz, Gurwitsch, Fink, Merleau-Ponty, Sartre, Levinas, Ricoeur and Henry. Like any other philosophical tradition, the phenomenological tradition spans many differences. This also holds true for its treatment and analysis of the self. In short, there is not one single phenomenological account of the self, just as there is not one single account of the self to be found in analytical philosophy. There are a variety of different accounts. In what follows, I have consequently been forced to make a certain selection, and to focus on what I take to be one of the most promising proposals.

Abstract

Abstract

In this chapter, we want to try and integrate the divergent lines introduced in the other parts of this book. We propose a model of self-consciousness derived from phenomenology, philosophy, the cognitive and neurosciences. We will then give an overview of research data on self-processing from various fields and link it to our model. Some aspects of the disturbances of the self in pathological states such as brain lesions and schizophrenia will be discussed. Finally, the clinically important concept of insight into a disease and its neurocognitive origin will be introduced. We argue that self-consciousness is a valid construct and, as shown in this chapter, it is possible that it can be studied with the instruments of cognitive neuroscience.

Introduction

The self as an entity distinct from the other has entered western thought through Greek philosophy (see chapter 1, this volume, for details). Throughout history, a myriad of different notions, starting from theology, philosophy, psychoanalysis, to early psychological concepts, psychopathology, the social sciences, and, more recently, cognitive psychology, neurology and the neurosciences have been developed. With the advent of scientific interest in consciousness towards the end of the twentieth century, self-consciousness has also become a topic taken up by the neuroscientific community. As a first phenomenological approximation based on commonly shared experience, we know that we are the same person across time, that we are the author of our thoughts/actions, and that we are distinct from the environment.

Abstract

The concept of self is a construct. It is not a ‘natural kind’ sited somewhere in the human brain. The western concept of self emphasizes individualism and autonomy but this view is cultural and no more scientific or truthful or advanced than the syncytial or collective view of self developed in other cultures and which revolves around family or clan rather than individual. Originally meant by St Augustine to be just a metaphorical or virtual space within which theological models of responsibility, guilt and sin could be played out, the self regained importance in the hands of Luther who started its reification as a private cave where god and man would regularly meet to sort out their differences. During the seventeenth century, the metaphors of the Reformation become secularized and built into liberalism and capitalism. The self survived by becoming a conceptual prop for bourgeois notions such as individual ownership, natural rights and democracy.

Wanting to reinforce the political status quo, nineteenth-century science transformed the political self into a psychological entity and proceeded to ‘naturalize it’ (i.e. render it into a natural kind). This additional reification engendered curious inferences. One was the belief that a ‘self’ really existed inside the European mind and brain. This self was characterized as driving, organized, executive and with a capacity for leadership and domination.

Abstract

One of the most striking manifestations of schizophrenia is thought insertion. People suffering from this delusion believe they are not the author of thoughts which they nevertheless own as experiences. It seems that a person's sense of agency and sense of the boundary between mind and world can come apart. Schizophrenia thus vividly demonstrates that self-awareness is a complex construction of the brain. This point is widely appreciated. What is not so widely appreciated is how radically schizophrenia challenges our assumptions about the nature of the self. Most theorists endorse the traditional doctrine of the unity of consciousness, according to which a normal human brain generates a single consciousness at any instant in time. In this chapter we argue that phenomenal consciousness at each instant is actually a multiplicity: an aggregate of phenomenal elements, each of which is the product of a distinct consciousness-making mechanism in the brain. We then consider how certain aspects of self might emerge from this manifold substrate, and speculate about the origin of thought insertion.

Introduction

Schizophrenia is a complex and heterogeneous disease, incorporating at least three distinct subsyndromes: psychomotor poverty (poverty of speech, lack of spontaneous movement, blunting of affect), disorganization (inappropriate affect, disturbances of the form of thought) and reality distortion (Liddle, 1987; Johnstone, 1991). The reality distortion syndrome encompasses the so-called ‘positive’ symptoms of schizophrenia, which include auditory hallucinations, delusions of persecution and delusions of reference. Of these, thought insertion is arguably the most bizarre.

Abstract

The purpose of this chapter is to review the evidence concerning mirror self-recognition as a measure of self-awareness and examine its applicability to schizophrenia. The evidence suggests that the ability to identify yourself correctly in a mirror is not only related to the capacity to conceive of yourself, but may also be related to your ability to take into account what other individuals may know, want or intend to do. This ability to make accurate inferences about mental states in others (known as mental state attribution, theory of mind or social intelligence) begins to emerge during childhood at the same point in time as mirror self-recognition. Species that fail to recognize themselves in mirrors fail to show any evidence that they can infer mental states in one another. Also consistent with the proposition that these phenomena go hand in hand, recent neuropsychological evidence shows that self-awareness and mental state attribution in humans appear to be a byproduct of brain activity that is related to the frontal cortex. As detailed here and elsewhere in this volume, there is growing evidence that both self-awareness and mental state attribution is impaired in schizophrenic patients and that schizophrenia may be related to frontal lobe dysfunction.

Mirror self-recognition

Mirrors have a number of unique psychological properties. In principle, mirrors represent a means of seeing yourself as you are seen by others. In front of a mirror you are literally an audience to your own behaviour.

Who are we and what makes us who we are? Like our world, our self is a construction of our minds. But we do not live in isolation. The self is also a construction of our relations with other selves. And most intriguingly, the self is a construction of its relation with itself. One question is, how does the mind construct this world and ourselves in it? Constantly we think, feel, decide, perceive. Understanding how these things happen is central to our grasp of what kind of being we are. The way our mental life is constituted is also important to our understanding of who we are individually, because the variation of our mental lives constitutes our feeling of differentiation between our fellow humans. Mental states, unlike most other things of our everyday experience, have no spatial characteristics and they do not seem to belong to a world constituted by physical things. How to place our mental experience in the physical universe is therefore perplexing. Mental phenomena also interest us because we infer from ourselves that others have similar mental experiences. Social interactions require us to understand each other's thoughts and feelings. And language would not exist as a medium of expressing our inner world without our elaborate cognitive abilities. We seem to understand the content of our mind readily from our own experience. The problem arises when we try to know objectively, independently from ourselves, what we experience.

Abstract

A severe disorder of the self-experience is conceived as the common experiential denominator of the heterogeneous group of schizophrenic psychoses. The ego-pathology focuses on this ego-disorder in its five basic dimensions (vitality, activity, consistency/coherence, demarcation, and identity).

A population of 664 probands (552 schizophrenics, 25 borderline personality disorder, 87 depressive disorder, Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) American Psychiatric Association, 1987) was systematically studied using the Ego Pathology Inventory (53 items). The most important evaluation was the confirmatory factor analysis.

The self-experience of schizophrenics concerns the uncertainties, deficits or even annihilation of the five basic dimensions. Confirmatory factor analysis allows comparison between theoretical and empirical item allocation and shows a high congruence (kappa 0.95). Analysis of variance between the three diagnostic groups on the level of items as well as scales shows differences in the respective proband groups. External measurements serve as arguments for the validity of the model.

The concept of five basic dimensions of self-experience can be shown as a reliable, valid and viable approach to study empirically the disordered ego/self of schizophrenics and other diagnostic groups. Concerning therapeutic consequences, some hints for a need-adapted treatment are given with the aim of reconstructing the disordered self-experience, even in body awareness.

A detailed presentation of the psychopathology research reported in this article is published in Scharfetter (1996). The first article was published in English in 1981.

Abstract

The ability to attribute an action to its proper agent and to understand its meaning when it is produced by someone else are basic aspects of human social communication. Several psychiatric symptoms, such as those of schizophrenia, relate to a dysfunction of the awareness of one's own action as well as of recognition of actions performed by others. Such syndromes thus offer a framework for studying the determinants of the sense of agency, which ultimately allows one to attribute correctly actions to their veridical source. This chapter will report a series of experiments in normal subjects and schizophrenic patients dealing with the recognition of actions. The basic paradigm used in these experiments was to present the subject with simple actions which may or may not correspond to those they currently execute. Systematic distortions have been introduced, such that the threshold for accepting an action as one's own could be determined. In normal subjects, this threshold is relatively high, indicating the existence of a specific mode of processing for action signals, independent from visual processing used in other perceptual activities. In schizophrenic patients, this threshold is further increased, with a strong tendency to self-attribute actions which do not correspond to those they have performed. The results reveal a clear distinction between patient groups with and without hallucinations and/or delusions of influence. Influenced patients show a higher rate of self-attributions. These results point to schizophrenia and related disorders as a paradigmatic alteration of a ‘who?’ system for action monitoring and self-consciousness.

Abstract

Proper structures of self-narrative depend on at least four capacities in the narrator: (1) a capacity for temporal integration of information; (2) a capacity for minimal self-reference; (3) a capacity for encoding and retrieving autobiographical memories; (4) a capacity for engaging in reflective metacognition. This chapter explicates the cognitive, phenomenological, narratological and neurological details of these four capacities and their dysfunction in schizophrenia, as evidenced by schizophrenic self-narrative.

Introduction

The concept of the narrative self involves a diachronic and complex structure that depends on reflective experience and on factors that are conceptual, emotional and socially embedded. According to a narrative approach, persons constitute their own identity by formulating autobiographical narratives – life stories (Schechtman, 1996). In this chapter I want to explore issues pertaining to the generation and structure of the narrative self in schizophrenia. Normal generation of a narrative self depends on the proper functioning of a variety of cognitive capacities, including capacities for short-term temporal processing (working memory), self-awareness, episodic memory and reflective metacognition. Neuropsychological research suggests that in schizophrenia the mechanisms responsible for each of these elements are frequently disrupted. It should not be surprising that, as a result, schizophrenic narratives, and the self that is constituted through them, are problematic, both in structure and content. (Problems with narrative self-identity begin at the prodromal stage for preschizophrenic subjects at school age (Hartmann et al., 1984).

Abstract

In this study of schizophrenia and narrative identity, the author begins with a description of narrative identity and a discussion of the debate over narrative identity: a debate that pits theorists arguing that narrative structures are embedded in lived life against those claiming that self-narratives are fictive structures that bear no relation to life as actually lived. The author defends a centrist position that finds narrative identity in part emerging from the life of the individual and in part constructed by the individual. Against the background of this discussion he then presents the histories of three schizophrenic patients. The first is an example of a highly fragmented self-narrative. The second is a delusional self-narrative. Finally, the third history is that of a woman struggling over whether to think of herself in terms of a schizophrenic ‘illness’ narrative.

Introduction

In addressing the narrative self in schizophrenia, I will begin with the broader topic of the self as such. Contemporary discussions of the self divide into positions that view the self as an essence or substance and those that view it as a construct. The notion of self as essence or substance implies that there is something like a human nature that dictates the course of self-development through the life span. Philosophically, Aristotle is the central figure at the origin of this point of view; he argued that man has a ‘form’ which he realizes over the course of a life.

Abstract

The self and self-consciousness are investigated in such different disciplines as neuroscience, psychiatry and philosophy. The resulting theories of these investigations are as different as are these three sciences. This often leads to the question which of the theories should be considered as the best theory or even as the true theory.

However in this chapter we hold the opinion that none of the different theories is comprehensive in a way that covers all the questions brought up by the other disciplines. We think that this is due to the fact that the three different sciences start from different perspectives, namely the first-person perspective, second-person perspective and third-person perspective. Consequently their resulting theories cannot be regarded as an absolute truth, but only as true in the scope of their perspective.

In this chapter the different perspectives are characterized according to their epistemic limitations and abilities. Furthermore it is shown how these perspectives lead to characteristic implications concerning the theories of the self in the different sciences.

Introduction

The self and self-consciousness have always been important problems in philosophy, especially dealt with in the philosophy of mind (Gloy, 1998). However the recent philosophy of mind often refers to Descartes' theory as its beginning (Seager, 1999). His special methodology and his theses have deeply influenced many of his successors. Descartes begins with our reflective consciousness, which questions anything. It results in a fundamental doubt towards everything except the fact that we think or doubt, e.g. the consciousness or the mind does not doubt its own existence.

Abstract

In this chapter we have explored the model of impaired self-monitoring which has been proposed to underlie the pathophysiology of auditory hallucinations and delusions in schizophrenia. We begin with an overview of the model from its beginnings in sensorimotor literature to its elaboration by Chris Frith. We then review the neuropsychological support and functional neuroimaging data of verbal self-monitoring in healthy individuals, inner speech and auditory hallucinations. A summary of our most recent data of overt verbal self-monitoring as measured by functional magnetic resonance imaging in healthy individuals as well as in patients with schizophrenia, both acutely psychotic and in remission, follows. We complete the chapter with a proposal for the neural circuitry involved in self-monitoring based on our behavioural and neuroimaging data and proposals for future research.

Introduction

That we recognize our thoughts, even the most bizarre and unpleasant ones, as arising from our own minds is a phenomenon which we take for granted. Associated with this is our ability to distinguish ourselves from others at a basic physical level and in terms of more nebulous concepts like ideas, beliefs and values. Yet most of us can also recall moments, such as upon wakening, when we've wondered if an experience was real or a dream. The experience of psychosis may represent an extreme example of this uncertainty. A hallucination, one of the cardinal features of psychosis, is a perception which occurs in the absence of a corresponding sensory stimulus.

Abstract

This chapter opens by outlining the basic architecture of interacting cognitive subsystems (Barnard, 1985, 1999) and then briefly summarizes its application to depression (Barnard & Teasdale, 1991; Teasdale & Barnard, 1993). The account of depression relies on the idea that cognitive-affective processes involve two distinct kinds of meaning: propositional meaning and implicational meaning. Propositional meaning is referentially specific while implicational meaning is more abstract and generic in nature. Affect and ideation are linked up in schematic models encoded as implicational meanings. Among other things, these schematic models represent our sense of self. In a context where negative self-schematic models dominate mental processing, feedback from propositional and body state representations acts to regenerate negative self-models and, in doing so, sustains depression.

The chapter then considers how the mechanisms underlying processing exchanges between two types of meaning can be extended to develop accounts of the core symptoms of a broader range of psychopathologies and the individual variation so often seen in symptom expression. The extension postulates four underlying sources of variation that constrain the dynamic processing of meaning. They are: (1) variation in the content of semantic representations; (2) variation in the rate of change in the content of mental images; (3) variation in the mode in which mental processes operate; and (4) variation in the synchronization of the processes that generate meaning. All four sources of variation are needed to account for variation in symptom expression across and within types of psychopathology.