The phenomenological nature of schizophrenia and disorder of selfhood.

Schizophrenia's resistance to understanding its causes may stem from neglecting its characteristic overall pattern (Gestalt) of psychopathological structure. Disorders of selfhood play a crucial role in forming this Gestalt. A phenomenological account of the self is presented, followed by basic complaints in schizophrenia that reflect a disordered selfhood, often dating back to childhood. Characteristic features of schizophrenic psychosis include "double bookkeeping," where hallucinations, delusions, and double bookkeeping are all linked to instability of the self. Self-disorders play an important diagnostic role in encounters with patients. The article emphasizes the role of phenomenology in psychiatric research.

Study at a glance

Abstract

Schizophrenia continues its resistance to the pathogenetic understanding. We believe that one of the reasons is an oblivion of schizophrenia's characteristic Gestalt expressive of its psychopathological structure. In this article we argue for a crucial role of disorders of selfhood in the constitution of this Gestalt. First, we present a phenomenological account of the self. This is followed by an exposition of basic complaints in schizophrenia which are reflective of a disordered selfhood and which often date back to childhood. We then present characteristic features of the schizophrenic psychosis with its phenomenon of "double bookkeeping". Hallucinations, delusions and double bookkeeping are all associated with the instability of the self. Finally, we briefly address characteristic aspects of the encounter with a schizophrenia patient and argue that self-disorders play an important diagnostic role. We conclude by emphasizing the role of phenomenology in psychiatric research.