Disorder of Selfhood in Schizophrenia: A Symptom or a Gestalt?
Karl Erik Sandsten, Dan Zahavi, Josef Parnas
Psychopathology 2022 DOI: 10.1159/000524100 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Qualitative study Peer reviewed |
|---|---|
| Sample size | 4 |
| Population | Patients with schizophrenia |
| Topics | Philosophy of mind |
| Keywords | Minimal self Psychopathology Schizophrenia Self-disorders |
| Citations | 42 |
| Key findings | Self-disorders in schizophrenia reflect a Gestalt of pervasive disturbance of self-experience, not isolated symptoms. |
Abstract
The concept of schizophrenia (SCZ) was originally associated with a disorder of formal strata of the self. During the last two decades, empirical studies have demonstrated a selective hyper-aggregation of self-disorders in the SCZ spectrum. As with other scientific research areas, the role of self-disturbances in SCZ has been up for debate in various disciplines including cognitive sciences, philosophy of mind, and psychopathology. Several philosophical papers have used the psychopathological phenomena of "thought insertion" as an alleged example of a complete loss of minimal selfhood. In the field of psychopathology, it has been claimed that self-disorders may comprise a transdiagnostic phenotype. Common to these approaches is the underlying assumption that self-disorders reflect well-delineated and isolated symptoms akin to the notion of symptom in the medical model. The aim of this paper was to argue that the clinical manifestation of self-disturbances is to be seen as aspects of a Gestalt of disturbed experiential selfhood. Seven videotaped interviews of patients with SCZ who were emblematic of very diverse symptomatological constellations were selected and jointly watched and discussed by the authors, who reached a consensus assessment. The interviews were semi-structured and narrative in nature in order to obtain faithful self-descriptions according to the standards of phenomenologically oriented interviews. For the purpose of this article, we chose 4 videos from which excerpts were verbatim transcribed and translated from Danish into English. The patients describe unique combinations of various psychopathological phenomena such as diminished sense of embodied self-presence, loss of ego boundaries, diminished sense of self, alienation and objectification of the experiential processes, mirror-phenomena, and Schneiderian passivity phenomena. Through an interweaving of the four vignettes and their subsequent psychopathological discussions, we argue that the invariant commonality across the different symptomatic expressions in these patients resides in a Gestalt of pervasive disturbance of self-experience. From a phenomenological perspective, these self-disturbances target a basic structure of phenomenal consciousness, namely, the first-person givenness of experience. We conclude that self-disorders reflect a trait-instability in the most basic structures of consciousness in SCZ and that its clinical manifestations are to be seen as aspects of a particular Gestalt rather than appearing as separate and well-delineated symptoms.
Comparable studies
Other qualitative studies on philosophy of mind, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Qualitative thematic analysis of the phenomenology of near-death experiences Cardiac arrest survivors | 2018 | Qualitative study | n = 34 |
| Phenomenology and Sequelae of 3,4-Methylenedioxymethamphetamine Use Psychiatrists who had taken MDMA | 1992 | Qualitative study | n = 20 |
| A phenomenology of meditation-induced light experiences: traditional buddhist and neurobiological perspectives American Buddhist practitioners | 2014 | Qualitative study | |
| Evoking the ineffable: The phenomenology of extreme sports. Extreme sports participants across three continents, including BASE jumping, big wave... | 2017 | Qualitative study | n = 15 |
| Phenomenology and content of the inhaled N, N-dimethyltryptamine (N, N-DMT) experience. Naturalistic inhaled N,N-DMT experiences posted to the r/DMT Reddit community | 2022 | Qualitative analysis | n = 3,778 |
Citations in the library
Cited by 5
- Phenomenology of auditory verbal hallucination in schizophrenia: An erroneous perception or something else? Schizophrenia Research March 1, 2024
- The phenomenological nature of schizophrenia and disorder of selfhood. Schizophrenia Research August 1, 2024
- Ontogenesis of self-disorders in the schizophrenia spectrum: A phenomenological neuro-developmental model. Schizophrenia Research October 1, 2024
- From Experience to Symptoms: A Multilayer Hierarchy of Psychopathological Dimensions in Schizophrenia. Psychopathology June 30, 2025
- An Empirical-Phenomenological Exploration of Anderssein (Feeling Different) in Schizophrenia: Being in-between Particular and Universal. Psychopathology 2024
Cites 7
- Double bookkeeping and schizophrenia spectrum: divided unified phenomenal consciousness. European Archives of Psychiatry and Clinical Neuroscience December 1, 2021
- Disordered Selfhood in Schizophrenia and the Examination of Anomalous Self-Experience: Accumulated Evidence and Experience. Psychopathology 2021
- Altered self-recognition in patients with schizophrenia. Schizophrenia Research April 1, 2020
- Basic Self-Disturbances beyond Schizophrenia: Discrepancies and Affinities in Panic Disorder - An Empirical Clinical Study. Psychopathology 2017
- The Self in the Spectrum: A Closer Look at the Temporal Stability of Self-Disorders in Schizophrenia. Psychopathology 2018
and 2 more in the library